MEDICARE: DR. MICHAEL P VIGNOGNA 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
1	2084P0800X	Psychiatry Physician	ME 121963	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	404578	OTHER	RI	BLUE CHIP
2	308881	OTHER	RI	BC
3	1524464	OTHER	RI	UBH

General Provider Information

NPI Number	:	1922114842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL P VIGNOGNA MD

Provider Business Mailing Address
First Line	:	3800 W BROWARD BLVD
Second Line	:	STE 100
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-1018
Country	:	US
Telephone Number	:	954-587-1008
Fax Number	:	954-990-2198

Provider Business Practice Location Address
First Line	:	3800 W BROWARD BLVD
Second Line	:	STE 100
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-1018
Country	:	US
Telephone Number	:	954-587-1008
Fax Number	:	954-990-2198

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	11/08/2016

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