| Organization Name: | MICHAEL W FORMISANO MD PA |
| NPI Number: | 1639365158 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL W FORMISANO (PRESIDENT) |
| Mailing Address: | 4024 N Circle Dr Hollywood |
| State: | FL US |
| Postal Code: | 330216726 |
| Phone Number: | 9549894110 |
| Fax Number: | 9549897855 |
| NPI Enumeration Date: | 09/18/2007 |
| NPI Last Update Date: | 11/15/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME 91614 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |