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General NPI Number Information
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NPI Number | 1639344914
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Entity Type | Individual
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Provider Name | MIKHAILIA WANAKEE LAKE MD
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Gender | Female
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 1625 SE 3RD AVE STE 620
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2521
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Country | US
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Telephone | 954-320-3380
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Fax | 954-320-3371
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Provider Business Mailing Address
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Address Line | 1608 SE 3RD AVE FL 3
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2564
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Country | US
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Telephone | 954-320-3380
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Fax | 954-320-3371
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME 112403
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License Number State | FL
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