Provider Demographics
NPI:1457371627
Name:GIRGIS, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GIRGIS
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 1:10443 TRIANON PL
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8075
Mailing Address - Country:US
Mailing Address - Phone:561-247-3609
Mailing Address - Fax:561-828-3190
Practice Address - Street 1:125 S. STATE ROAD 7
Practice Address - Street 2:SUITE 104 - #343
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-247-3609
Practice Address - Fax:561-828-3190
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4793207Q00000X
FLME115763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199330504Medicaid
TX8CG797OtherBCBS INDIVIDUAL PROVIDER NUMBER
TX199330505OtherMEDICAID CSHCN (CHILDRENS SPECIAL HEALTH CARE NEEDS) IND PP#
TX199330504Medicaid
TX265179YMSKMedicare PIN