Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RP1001X | Pulmonary Disease | ME0014617 | FL |
Y | 207RS0012X | Sleep Medicine | ME14617 | FL |
NPI | 1013909977 |
---|---|
Provider Name | Edward Michaelson |
First Address | Fort Lauderdale, FL 33308-1916 |
Second Address | Fort Lauderdale, FL 33309-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 04/06/2010 |