Provider Demographics
NPI:1699854562
Name:LIGOTTI, MICHAEL JOHN (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:LIGOTTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 832078
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-0278
Mailing Address - Country:US
Mailing Address - Phone:561-265-1990
Mailing Address - Fax:561-330-9011
Practice Address - Street 1:402 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5231
Practice Address - Country:US
Practice Address - Phone:561-265-1990
Practice Address - Fax:561-330-9011
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9035207Q00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL203173905OtherTAX ID NUMBER
FL203173905OtherTAX ID NUMBER
FL28775ZMedicare PIN