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NPI Code Detail

MEDICARE: MR. MICHAEL P DORN

MEDICARE: MR. MICHAEL P DORN
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
1183500000XPharmacistPS19691FL

General Provider Information

NPI Number : 1346518305
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL P DORN
Provider Business Mailing Address
First Line : 1613 N VICTORIA PARK RD
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33305-3405
Country : US
Telephone Number : 954-566-4346
Fax Number :
Provider Business Practice Location Address
First Line : 2355 NE 26TH ST
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33305-1628
Country : US
Telephone Number : 954-561-3880
Fax Number : 954-564-6653
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2011
Last Update Date : 12/06/2011

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