1295748176 NPI number — DR. MICHAEL DIAZ MD

Table of content: DR. MICHAEL DIAZ MD (NPI 1295748176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295748176 NPI number — DR. MICHAEL DIAZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295748176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1513 S HARBOR CITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32901-4681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-951-2639
Provider Business Mailing Address Fax Number:
321-914-0938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1513 S HARBOR CITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-951-2639
Provider Business Practice Location Address Fax Number:
321-914-0938
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME74679 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1033065 . This is a "CAREPLUS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: EFFECTIVE 07/14/208 . This is a "COALITION AMERICA/NPPN" identifier . This identifiers is of the category "OTHER".
  • Identifier: EFFECTIVE 08/07/2008 . This is a "EVOLUTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: EFFECTIVE 10/01/2008 . This is a "UNITEDHEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01226797 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 44932 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 458713 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: EFFECTIVE 10/23/08 . This is a "MULTIPLAN/PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: EFFECTIVE 11/01/2007 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6684138 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: EFFECTIVE 01/01/2009 . This is a "ACCOUNTABLE/INTERPLAN HEALTH GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: EFFECTIVE 12/29/2008 . This is a "HUMANA CHOICE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2580722 . This is a "BEECHSTREET NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7381303 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: EFFECTIVE 10/20/2008 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: EFFECTIVE 10/30/2008 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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