Provider Demographics
NPI:1477694255
Name:STORCH, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:STORCH
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 1:21110 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1227
Mailing Address - Country:US
Mailing Address - Phone:305-932-3200
Mailing Address - Fax:305-933-3366
Practice Address - Street 1:21110 BISCAYNE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1227
Practice Address - Country:US
Practice Address - Phone:305-932-3200
Practice Address - Fax:305-933-3366
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME16540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC07845Medicare UPIN
FL95105Medicare ID - Type Unspecified