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General NPI Number Information
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NPI Number | 1174868855
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Entity Type | Individual
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Provider Name | MICHAEL IYAMU D.O
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Gender | Male
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 7031 SW 62ND AVE
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4701
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Country | US
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Telephone | 305-284-7761
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Fax |
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Provider Business Mailing Address
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Address Line | 8650 SW 212TH ST APT. 303
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City | CUTLER BAY
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State | FL
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Zip | 33189-3757
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Country | US
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Telephone | 832-661-2385
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | UO3406
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License Number State | FL
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