Provider Demographics
NPI:1700896206
Name:MISHKIN, DAVID B (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:MISHKIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2021 E COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-202-7899
Mailing Address - Fax:954-202-7877
Practice Address - Street 1:2021 E COMMERCIAL BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-202-7899
Practice Address - Fax:954-202-7877
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 8314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269939700Medicaid
H55470Medicare UPIN
FL269939700Medicaid