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General NPI Number Information
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NPI Number | 1881213650
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Entity Type | Individual
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Provider Name | MARY MICHAEL
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Gender | Female
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 1001 NW 13TH ST STE 100
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City | BOCA RATON
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State | FL
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Zip | 33486-2269
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Country | US
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Telephone | 305-740-6140
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 MUIRFIELD WAY
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City | OLDSMAR
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State | FL
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Zip | 34677-1935
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Country | US
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Telephone | 727-389-8252
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OS18944
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS18944
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License Number State | FL
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