Provider Demographics
NPI:1477668440
Name:MIKHAIL, HODA A
Entity type:Individual
Prefix:
First Name:HODA
Middle Name:A
Last Name:MIKHAIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-7035
Mailing Address - Country:US
Mailing Address - Phone:954-418-0118
Mailing Address - Fax:954-481-4460
Practice Address - Street 1:2100 E SAMPLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7574
Practice Address - Country:US
Practice Address - Phone:954-418-0118
Practice Address - Fax:954-481-4460
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45309208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069649800Medicaid
FL069649800Medicaid