1447343033 NPI number — DR. MICHELLE D DETWEILER DPM

Table of content: DR. MICHELLE D DETWEILER DPM (NPI 1447343033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447343033 NPI number — DR. MICHELLE D DETWEILER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DETWEILER
Provider First Name:
MICHELLE
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

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:
1447343033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 NW 27 ST
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33122-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-662-3893
Provider Business Mailing Address Fax Number:
786-662-3899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8280 NW 27 ST
Provider Second Line Business Practice Location Address:
SUITE 505
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33122-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-673-0033
Provider Business Practice Location Address Fax Number:
305-673-9259
Provider Enumeration Date:
10/02/2006

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: 213ES0103X , with the licence number:  PO2403 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: PO2403 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: PO2403 , 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: 390635100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390194700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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