Healthcare Provider Details

I. General information

NPI: 1518684513
Provider Name (Legal Business Name): DIEUVEUT MICHEL PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 FOREST HILL BLVD
WEST PALM BEACH FL
33406-6073
US

IV. Provider business mailing address

2476 TIMBER FOREST DR
WEST PALM BEACH FL
33415-3625
US

V. Phone/Fax

Practice location:
  • Phone: 786-567-2561
  • Fax:
Mailing address:
  • Phone: 575-605-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9651
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number049629
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1242
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11037400
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9574670
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number22662
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: