Provider Demographics
NPI:1639158850
Name:ANESTA, MICHAEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:ANESTA
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 1:900 NW 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2519
Mailing Address - Country:US
Mailing Address - Phone:561-278-3323
Mailing Address - Fax:561-274-3963
Practice Address - Street 1:900 NW 17TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2519
Practice Address - Country:US
Practice Address - Phone:561-278-3323
Practice Address - Fax:561-274-3963
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42013207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036101100Medicaid
61278ZMedicare PIN
FL036101100Medicaid
FLD57169Medicare UPIN