Provider Demographics
NPI:1124016332
Name:MORRISON, MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:MORRISON
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 1:4101 NW 4TH ST
Mailing Address - Street 2:STE 109
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2850
Mailing Address - Country:US
Mailing Address - Phone:954-792-6900
Mailing Address - Fax:954-792-0615
Practice Address - Street 1:4101 NW 4TH ST
Practice Address - Street 2:STE 109
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2850
Practice Address - Country:US
Practice Address - Phone:954-792-6900
Practice Address - Fax:954-792-0615
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07745OtherBLUE CROSS BLUE SHIELD
FL07745BOtherBLUE CROSS BLUE SHIELD
FL256721100Medicaid
FL256721100Medicaid
FL07745OtherBLUE CROSS BLUE SHIELD
07745YMedicare ID - Type Unspecified