Provider Demographics
NPI:1598945602
Name:ROSS, MICHAEL L (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:ROSS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:8200 SW 117TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4825
Mailing Address - Country:US
Mailing Address - Phone:305-279-7677
Mailing Address - Fax:305-279-0977
Practice Address - Street 1:8200 SW 117TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4825
Practice Address - Country:US
Practice Address - Phone:305-279-7677
Practice Address - Fax:305-279-0977
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2011-12-23
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Provider Licenses
StateLicense IDTaxonomies
FLOS0005757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE86993Medicare UPIN
FL80475Medicare PIN