Provider Demographics
NPI:1205957784
Name:BUITRAGO, MIKE E (ARNP)
Entity type:Individual
Prefix:MR
First Name:MIKE
Middle Name:E
Last Name:BUITRAGO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
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Mailing Address - Street 1:8251 W BROWARD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2703
Mailing Address - Country:US
Mailing Address - Phone:954-475-9535
Mailing Address - Fax:954-475-4637
Practice Address - Street 1:8251 W BROWARD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2703
Practice Address - Country:US
Practice Address - Phone:954-475-9535
Practice Address - Fax:954-475-4637
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP2982202363L00000X
FLARNP 2982202363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0628ZMedicare UPIN