Provider Demographics
NPI:1609967512
Name:WILENSKY, MICHAEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:WILENSKY
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 1:17971 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0033139174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1932373958OtherMEDICARE NPI
FL95466OtherBLUE SHIELD NUMBER
FLME0033139OtherMEDICAL LICENSE NUMBER
FL1932373958OtherMEDICARE NPI