Provider Demographics
NPI:1891784179
Name:DORVAL, MICHEL EVANS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHEL
Middle Name:EVANS
Last Name:DORVAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5936
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:305-891-5515
Practice Address - Street 1:1200 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5936
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:305-891-5515
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101758363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009220100Medicaid
E8497WMedicare ID - Type Unspecified
FLP72636Medicare UPIN