MEDICARE: DR. PAULA MICHELE THAQI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME82364	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AI032Y	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	37981	OTHER	FL	BLUE CROSS PROVIDER NUMBE

General Provider Information

NPI Number	:	1003885765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA MICHELE THAQI M.D.

Provider Business Mailing Address
First Line	:	780 SW 24TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-2643
Country	:	US
Telephone Number	:	954-467-4700
Fax Number	:	954-467-4704

Provider Business Practice Location Address
First Line	:	780 SW 24TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-2643
Country	:	US
Telephone Number	:	954-467-4700
Fax Number	:	954-467-4704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	07/25/2022

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