Provider Demographics
NPI:1134184740
Name:KANNER, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KANNER
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 1:4651 SHERIDAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3459
Mailing Address - Country:US
Mailing Address - Phone:954-894-1500
Mailing Address - Fax:954-894-1526
Practice Address - Street 1:4651 SHERIDAN ST STE 100
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3459
Practice Address - Country:US
Practice Address - Phone:954-894-1500
Practice Address - Fax:954-894-1526
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042160207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373342400Medicaid
FL373342400Medicaid
FL96286Medicare ID - Type Unspecified