Provider Demographics
NPI:1366690372
Name:MALTMAN, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:MALTMAN
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:PO BOX 1457
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34991-6457
Mailing Address - Country:US
Mailing Address - Phone:772-249-5256
Mailing Address - Fax:772-249-5274
Practice Address - Street 1:1523 SW SEA HOLLY WAY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-8530
Practice Address - Country:US
Practice Address - Phone:772-249-5256
Practice Address - Fax:772-249-5274
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102058207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000596200Medicaid
91842OtherBLUE CROSS FLORIDA
FL000596200Medicaid