Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO02315 | FL |
N | 222Z00000X | Podiatrist | CPO02315 | FL |
Y | 224P00000X | Prosthetist | CPO02315 | FL |
NPI | 1124111760 |
---|---|
Provider Name | Mr. Michael John Hogan |
First Address | Orlando, FL 32806-2935 |
Second Address | Orlando, FL 32806-2935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 03/06/2015 |