Organization Name: | M W FORMISANO MD PA |
NPI Number: | 1730315490 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL WILLIAM FORMISANO (PRESIDENT) |
Mailing Address: | 4024 N Circle Dr Hollywood |
State: | FL US |
Postal Code: | 330216726 |
Phone Number: | 9549894110 |
Fax Number: | 9549897855 |
NPI Enumeration Date: | 06/08/2009 |
NPI Last Update Date: | 06/08/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME91614 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |