Provider Demographics
NPI:1588654222
Name:MICHAEL, EHAB (MD)
Entity Type:Individual
Prefix:DR
First Name:EHAB
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5411 GRAND BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4011
Mailing Address - Country:US
Mailing Address - Phone:727-842-3600
Mailing Address - Fax:727-845-0732
Practice Address - Street 1:5411 GRAND BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4011
Practice Address - Country:US
Practice Address - Phone:727-842-3600
Practice Address - Fax:727-845-0732
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME67843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00185607OtherRAILROAD MEDICARE INDIVID
FLDC7779OtherRAILROAD MEDICARE GROUP
FL74767OtherBCBS GROUP
FL26901OtherBCBS INDIVIDUAL
FL26901AMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
FLP00185607OtherRAILROAD MEDICARE INDIVID
FL26901OtherBCBS INDIVIDUAL
FLF95471Medicare UPIN