Provider Demographics
NPI:1386850022
Name:MICHAEL, MAUREEN (BS)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7415 N DEVON DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1082
Mailing Address - Country:US
Mailing Address - Phone:954-726-0980
Mailing Address - Fax:954-341-2252
Practice Address - Street 1:7415 N DEVON DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1082
Practice Address - Country:US
Practice Address - Phone:954-726-0980
Practice Address - Fax:954-341-2252
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL222Q00000XOtherITDS