MEDICARE: DR. EHAB MICHAEL 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	207R00000X	Internal Medicine Physician	ME67843	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00185607	OTHER	FL	RAILROAD MEDICARE INDIVID
3	DC7779	OTHER	FL	RAILROAD MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26901	OTHER	FL	BCBS INDIVIDUAL
4	74767	OTHER	FL	BCBS GROUP

General Provider Information

NPI Number	:	1588654222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EHAB MICHAEL M.D.

Provider Business Mailing Address
First Line	:	5411 GRAND BLVD
Second Line	:	SUITE 101
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4011
Country	:	US
Telephone Number	:	727-842-3600
Fax Number	:	727-845-0732

Provider Business Practice Location Address
First Line	:	5411 GRAND BLVD
Second Line	:	SUITE 101
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4011
Country	:	US
Telephone Number	:	727-842-3600
Fax Number	:	727-845-0732

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	09/12/2024

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