Provider Demographics
NPI:1437117637
Name:TODD, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:TODD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4700 MILLENIA BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6013
Mailing Address - Country:US
Mailing Address - Phone:407-533-6836
Mailing Address - Fax:407-232-9316
Practice Address - Street 1:9108 CAMP BOWIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6098
Practice Address - Country:US
Practice Address - Phone:682-990-6492
Practice Address - Fax:877-688-9560
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO45727207RG0300X
IL036111736207RG0300X
TXR3610207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111736Medicaid
ILI35834Medicare UPIN