Healthcare Provider Details

I. General information

NPI: 1831145028
Provider Name (Legal Business Name): MONISE MARIE MAIGNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 N. MILITARY TRAIL MEDICINE (111)
WEST PALM BEACH FL
33410
US

IV. Provider business mailing address

7305 N. MILITARY TRAIL MEDICINE (111)
WEST PALM BEACH FL
33410
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-7486
  • Fax: 561-422-8708
Mailing address:
  • Phone: 561-422-7486
  • Fax: 561-422-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME83630
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: