Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | ME120612 | FL |
NPI | 1154423572 |
---|---|
Provider Name | Michael D Tsifansky |
First Address | Gainesville, FL 32608-4227 |
Second Address | Gainesville, FL 32610-0297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 09/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012737900 | (05) | FL |