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NPI Code Detail

MEDICARE: MICHAEL MITCHELL HALISTA MD

MEDICARE: MICHAEL MITCHELL HALISTA MD
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
1207RI0011XInterventional Cardiology PhysicianME174655FL

General Provider Information

NPI Number : 1346774205
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL MITCHELL HALISTA MD
Provider Business Mailing Address
First Line : PO BOX 20800
Second Line :
City : BELFAST
State : ME
Zip : 04915-4105
Country : US
Telephone Number : 469-803-3000
Fax Number :
Provider Business Practice Location Address
First Line : 5352 LINTON BLVD STE 100
Second Line :
City : DELRAY BEACH
State : FL
Zip : 33484-6514
Country : US
Telephone Number : 561-498-2249
Fax Number : 561-498-0320
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2017
Last Update Date : 04/21/2026

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