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General NPI Number Information
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NPI Number | 1831542182
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Entity Type | Organization
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Legal Business Name | MICHAEL MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 1150 N 35TH AVE SUITE 240
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5424
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Country | US
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Telephone | 954-362-3426
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Fax | 954-362-3432
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Provider Business Mailing Address
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Address Line | 21100 MADRIA CIR
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City | BOCA RATON
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State | FL
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Zip | 33433-2531
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Country | US
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Telephone | 954-362-3426
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Fax | 954-362-3432
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Authorized Official
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Title or Position | OWNER
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Name | PAUL MICHAEL
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Credential | MD
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Telephone | 954-362-3426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME124220
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License Number State | FL
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