Provider Demographics
NPI:1346630043
Name:MICHAEL A. DIAMOND M.D. PA
Entity Type:Organization
Organization Name:MICHAEL A. DIAMOND M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-279-2256
Mailing Address - Street 1:9220 SW 72ND ST
Mailing Address - Street 2:#200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3259
Mailing Address - Country:US
Mailing Address - Phone:305-279-2256
Mailing Address - Fax:305-598-0245
Practice Address - Street 1:9220 SW 72ND ST
Practice Address - Street 2:#200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3259
Practice Address - Country:US
Practice Address - Phone:305-279-2256
Practice Address - Fax:305-598-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 43348261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD64919Medicare UPIN