Healthcare Provider Details

I. General information

NPI: 1497476618
Provider Name (Legal Business Name): MICHAEL F YBERN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 SW PORT ST LUCIE BLVD
PORT ST LUCIE FL
34984-5031
US

IV. Provider business mailing address

461 NW 107TH AVE APT 2
MIAMI FL
33172-7806
US

V. Phone/Fax

Practice location:
  • Phone: 772-878-5000
  • Fax:
Mailing address:
  • Phone: 786-757-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number27510
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: