Provider Demographics
NPI:1710929757
Name:MICHAEL, EHAB S (MD)
Entity Type:Individual
Prefix:
First Name:EHAB
Middle Name:S
Last Name:MICHAEL
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 1:3920 BEE RIDGE RD STE E-E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1262
Mailing Address - Country:US
Mailing Address - Phone:941-777-0002
Mailing Address - Fax:941-777-0036
Practice Address - Street 1:3920 BEE RIDGE RD STE E-E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1262
Practice Address - Country:US
Practice Address - Phone:941-777-0002
Practice Address - Fax:941-777-0036
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39387207R00000X, 207P00000X, 208000000X
FLME118919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019313300Medicaid
FL14V0HOtherBCBS
FLQN680OtherMEDICARE
FLQN678OtherMEDICARE