Provider Demographics
NPI:1164712048
Name:MISHA DENHAM, DO PA
Entity Type:Organization
Organization Name:MISHA DENHAM, DO PA
Other - Org Name:ENDOCRINE SOLUTIONS OF SOUTH FL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-672-8559
Mailing Address - Street 1:2695 S LE JEUNE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5839
Mailing Address - Country:US
Mailing Address - Phone:305-672-8559
Mailing Address - Fax:305-672-9259
Practice Address - Street 1:2695 S LE JEUNE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5839
Practice Address - Country:US
Practice Address - Phone:305-672-8559
Practice Address - Fax:305-672-9259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9157207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003734400Medicaid
FL003734400Medicaid