Provider Demographics
NPI:1427023696
Name:AMBROSE, MICHAEL RAINER (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAINER
Last Name:AMBROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2315 MALYSA PL
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5906
Mailing Address - Country:US
Mailing Address - Phone:850-470-0815
Mailing Address - Fax:850-432-8398
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:SUITE 10 L
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-470-1649
Practice Address - Fax:850-432-8398
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 42284207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F46398Medicare UPIN