Provider Demographics
NPI:1518268432
Name:MICHAEL WILENSKY MD PA
Entity Type:Organization
Organization Name:MICHAEL WILENSKY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-948-8825
Mailing Address - Street 1:17971 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2578
Mailing Address - Country:US
Mailing Address - Phone:305-948-8825
Mailing Address - Fax:305-466-7045
Practice Address - Street 1:17971 BISCAYNE BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2578
Practice Address - Country:US
Practice Address - Phone:305-948-8825
Practice Address - Fax:305-466-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033139174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6863OtherMEDICARE GROUP NUMBER
FLK6863OtherMEDICARE GROUP NUMBER