Provider Demographics
NPI:1093855587
Name:NW FLORIDA LUNG ASSOCIATES, PA
Entity Type:Organization
Organization Name:NW FLORIDA LUNG ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-863-3000
Mailing Address - Street 1:322 RACETRACK RD NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2546
Mailing Address - Country:US
Mailing Address - Phone:850-863-3000
Mailing Address - Fax:850-374-3200
Practice Address - Street 1:322 RACETRACK RD NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2546
Practice Address - Country:US
Practice Address - Phone:850-863-3000
Practice Address - Fax:850-374-3200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NW FL LUNG ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058957174400000X
208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252347700Medicaid
FL252347700Medicaid
FL21279AMedicare ID - Type UnspecifiedGROUP #