Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | ME144238 | FL |
NPI | 1083058879 |
---|---|
Provider Name | Michael William Aversano |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021-5488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105758000 | (05) | FL |