Provider Demographics
NPI:1134250004
Name:GHATTAS, MICHEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:A
Last Name:GHATTAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHEL
Other - Middle Name:A
Other - Last Name:GHATTAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2301 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2629
Mailing Address - Country:US
Mailing Address - Phone:954-565-7281
Mailing Address - Fax:954-565-7281
Practice Address - Street 1:2301 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-2629
Practice Address - Country:US
Practice Address - Phone:954-565-7281
Practice Address - Fax:954-565-7281
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 88047207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology