1609967512 NPI number — DR. MICHAEL H WILENSKY M.D.

Table of content: DR. MICHAEL H WILENSKY M.D. (NPI 1609967512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609967512 NPI number — DR. MICHAEL H WILENSKY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILENSKY
Provider First Name:
MICHAEL
Provider Middle Name:
H
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:
1609967512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17971 BISCAYNE BLVD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
AVENTURA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33160-2578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-948-8825
Provider Business Mailing Address Fax Number:
305-466-7045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17971 BISCAYNE BLVD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33160-2578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-948-8825
Provider Business Practice Location Address Fax Number:
305-466-7045
Provider Enumeration Date:
09/27/2006

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:  ME-0033139 , 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: 1932373958 . This is a "MEDICARE NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 95466 . This is a "BLUE SHIELD NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME0033139 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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