Provider Demographics
NPI:1053468983
Name:GREGORIAN, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GREGORIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13550 SW 88TH ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1514
Mailing Address - Country:US
Mailing Address - Phone:305-385-9919
Mailing Address - Fax:305-386-9061
Practice Address - Street 1:13550 SW 88TH ST
Practice Address - Street 2:SUITE 180
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1514
Practice Address - Country:US
Practice Address - Phone:305-385-9919
Practice Address - Fax:305-386-9061
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL56235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061976100Medicaid
FLA62113Medicare UPIN
FL09712DMedicare ID - Type Unspecified