Provider Demographics
NPI:1508129115
Name:DE MICHELE, MARIANA LAURA (MD)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:LAURA
Last Name:DE MICHELE
Suffix:
Gender:F
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:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1633
Mailing Address - Country:US
Mailing Address - Phone:786-594-6880
Mailing Address - Fax:
Practice Address - Street 1:8940 N KENDALL DR STE 905E
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2176
Practice Address - Country:US
Practice Address - Phone:786-595-5007
Practice Address - Fax:786-533-9562
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101007207R00000X
FLME157547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine