Provider Demographics
NPI:1881662716
Name:HOROWITZ, MICHAEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:HOROWITZ
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 1:1887 KINGSLEY AVE STE 1900
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4451
Mailing Address - Country:US
Mailing Address - Phone:904-276-7336
Mailing Address - Fax:904-276-7337
Practice Address - Street 1:1887 KINGSLEY AVE STE 1900
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4451
Practice Address - Country:US
Practice Address - Phone:904-276-7336
Practice Address - Fax:904-276-7337
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043535L207T00000X
FLME140930207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017519700003Medicaid
PA027953Medicare PIN
PA0017519700003Medicaid