Provider Demographics
NPI:1649308669
Name:KIRWAN, MICHELLE ANNE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNE
Last Name:KIRWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19380 COLLINS AVE APT 1212
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 S HOSPITAL DR STE 110
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2831
Practice Address - Country:US
Practice Address - Phone:954-584-8222
Practice Address - Fax:954-584-8224
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88448208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267657500Medicaid
FL267657500Medicaid