Provider Demographics
NPI:1053469312
Name:DEICHEN, MICHAEL GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GERARD
Last Name:DEICHEN
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:UNIVERSITY OF CENTRAL FLORIDA HEALTH SERVICES
Mailing Address - Street 2:4000 CENTRAL FLORIDA BLVD.
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32816-3333
Mailing Address - Country:US
Mailing Address - Phone:407-823-0260
Mailing Address - Fax:407-823-0417
Practice Address - Street 1:UNIVERSITY OF CENTRAL FLORIDA HEALTH SERVICES
Practice Address - Street 2:4000 CENTRAL FLORIDA BLVD.
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-3333
Practice Address - Country:US
Practice Address - Phone:407-823-0260
Practice Address - Fax:407-823-0417
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine