Provider Demographics
NPI:1083690796
Name:SOMERO, MICHAEL STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:SOMERO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8310
Mailing Address - Country:US
Mailing Address - Phone:407-390-1677
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:SUITE 950/960
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3316
Practice Address - Country:US
Practice Address - Phone:305-538-1400
Practice Address - Fax:305-538-6102
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-06-22
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Provider Licenses
StateLicense IDTaxonomies
FLME116417207R00000X
CAG77068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012236200Medicaid
CA1508026725Medicaid
CA440002198OtherRAILROAD MEDICARE
CAF69116Medicare UPIN