Provider Demographics
NPI:1477879229
Name:MICHAEL, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:MICHAEL
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 1:4240 SUN N LAKE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1944
Mailing Address - Country:US
Mailing Address - Phone:863-471-3926
Mailing Address - Fax:863-385-3093
Practice Address - Street 1:4240 SUN N LAKE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-1944
Practice Address - Country:US
Practice Address - Phone:863-471-3926
Practice Address - Fax:863-385-3093
Is Sole Proprietor?:No
Enumeration Date:2010-04-18
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124220207R00000X, 207RC0000X, 207RI0011X, 207RI0011X
LAMD.203664207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME124220OtherMD MEDICAL LICENSE
FL015021200Medicaid
FLME124220OtherMD MEDICAL LICENSE
FLFM3495923OtherDEA
FL015021200Medicaid
FLME124220OtherMD MEDICAL LICENSE
MSP01206665OtherRAILROAD MEDICARE