Provider Demographics
NPI:1134155294
Name:VANDORMAEL, MICHEL GUY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:GUY
Last Name:VANDORMAEL
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 1:2000 NW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2654
Mailing Address - Country:US
Mailing Address - Phone:844-665-4827
Mailing Address - Fax:866-523-6595
Practice Address - Street 1:15600 NW 67TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2176
Practice Address - Country:US
Practice Address - Phone:844-665-4827
Practice Address - Fax:877-807-0603
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87973207RC0000X
FLME 87973207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA12448Medicare UPIN
FL46092UMedicare PIN