Provider Demographics
NPI:1033389200
Name:MICHAEL J. AYRES, DPM, PA
Entity Type:Organization
Organization Name:MICHAEL J. AYRES, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:321-722-0000
Mailing Address - Street 1:910 MALABAR RD SE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3200
Mailing Address - Country:US
Mailing Address - Phone:321-722-0000
Mailing Address - Fax:321-768-0085
Practice Address - Street 1:910 MALABAR RD SE
Practice Address - Street 2:SUITE #1
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3200
Practice Address - Country:US
Practice Address - Phone:321-722-0000
Practice Address - Fax:321-768-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0875400001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0875400001Medicare NSC