Provider Demographics
NPI:1639132459
Name:FLOYD REBOLLO, MICHELLE K (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:K
Last Name:FLOYD REBOLLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7900 NW 27TH AVE # 12
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-4909
Mailing Address - Country:US
Mailing Address - Phone:786-318-2337
Mailing Address - Fax:786-228-4963
Practice Address - Street 1:7900 NW 27TH AVE STE E-12
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4909
Practice Address - Country:US
Practice Address - Phone:786-318-2337
Practice Address - Fax:786-228-4963
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME156123208000000X, 208000000X
IL036-126091208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2702851-00Medicaid
FL115358300Medicaid
FL2702851-00Medicaid