Provider Demographics
NPI:1205859188
Name:PIERCE, MICHAEL NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NORMAN
Last Name:PIERCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14303
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33302-4303
Mailing Address - Country:US
Mailing Address - Phone:954-530-9591
Mailing Address - Fax:954-530-9597
Practice Address - Street 1:4055 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-5269
Practice Address - Country:US
Practice Address - Phone:954-530-9591
Practice Address - Fax:954-530-9597
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY204864207R00000X
FLME81857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012343700Medicaid
NY02241541Medicaid
NY040AV1OtherMEDICARE ID
FL123280OtherBCBS
FLHX572ZMedicare UPIN
NY02241541Medicaid