1588654222 NPI number — DR. EHAB MICHAEL M.D.

Table of content: DR. EHAB MICHAEL M.D. (NPI 1588654222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588654222 NPI number — DR. EHAB MICHAEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHAEL
Provider First Name:
EHAB
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1588654222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5411 GRAND BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
NEW PORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34652-4011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-842-3600
Provider Business Mailing Address Fax Number:
727-845-0732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5411 GRAND BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34652-4011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-842-3600
Provider Business Practice Location Address Fax Number:
727-845-0732
Provider Enumeration Date:
10/25/2005

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: 207R00000X , with the licence number:  ME67843 , 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: P00185607 . This is a "RAILROAD MEDICARE INDIVID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DC7779 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 74767 . This is a "BCBS GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 26901 . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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