Provider Demographics
NPI:1932762838
Name:GERAGHTY, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:GERAGHTY
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:DON SOFFER CLINICAL RESEARCH CENTER
Mailing Address - Street 2:1120 NW 14TH STREET, 4TH FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DON SOFFER CLINICAL RESEARCH CENTER
Practice Address - Street 2:1120 NW 14TH STREET, 4TH FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015
Practice Address - Country:US
Practice Address - Phone:305-243-0371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL167793208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program