Provider Demographics
NPI:1134122963
Name:ARUTA, MIICHAEL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIICHAEL
Middle Name:JOHN
Last Name:ARUTA
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 1:2151 E COMMERCIAL BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3807
Mailing Address - Country:US
Mailing Address - Phone:954-727-2008
Mailing Address - Fax:954-727-2009
Practice Address - Street 1:2151 E COMMERCIAL BLVD
Practice Address - Street 2:STE 204
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3807
Practice Address - Country:US
Practice Address - Phone:954-727-2008
Practice Address - Fax:954-727-2009
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6767583OtherUNITED HEALTHCARE
FLBA6733578OtherDEA
FL14368Medicare ID - Type Unspecified
FLF09072Medicare UPIN