Provider Demographics
NPI:1841222403
Name:AMBROSE, MICHAEL F (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:AMBROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3345 BURNS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4305
Mailing Address - Country:US
Mailing Address - Phone:843-383-3634
Mailing Address - Fax:843-383-4125
Practice Address - Street 1:3345 BURNS RD STE 202
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4305
Practice Address - Country:US
Practice Address - Phone:843-383-3634
Practice Address - Fax:843-383-4125
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22926207Q00000X
FLME83524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH54570Medicare UPIN