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General NPI Number Information
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NPI Number | 1336576230
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Entity Type | Organization
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Legal Business Name | MICHAEL MCIVOR MD PA
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Dates
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Enumeration Date | 10/09/2013
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 1010 KENNEDY DR #400
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City | KEY WEST
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State | FL
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Zip | 33040-4134
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Country | US
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Telephone | 305-842-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 KEY PLZ #334
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City | KEY WEST
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State | FL
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Zip | 33040-4077
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Country | US
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Telephone | 305-842-1101
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | DR. MICHAEL E MCIVOR
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Credential | MD
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Telephone | 305-842-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 53954
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License Number State | FL
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