| Michael Fish Phd Pa | |
|
10200 W State Road 84 Ste 105 Davie FL 33324-4218 | |
| (954) 370-7692 | |
| (954) 370-2383 |
| Full Name | Michael Fish Phd Pa |
|---|---|
| Speciality | Psychologist |
| Location | 10200 W State Road 84 Ste 105, Davie, Florida |
| Authorized Official Name and Position | Michael Fish (PRESIDENT/PSYCHOLOGIST) |
| Authorized Official Contact | 9543707692 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Fish Phd Pa 1304 Sw 160th Ave Suite 339 Sunrise FL 33326-1902 Ph: (954) 370-7692 | Michael Fish Phd Pa 10200 W State Road 84 Ste 105 Davie FL 33324-4218 Ph: (954) 370-7692 |
| NPI Number | 1376723478 |
|---|---|
| Provider Enumeration Date | 11/06/2007 |
| Last Update Date | 10/09/2017 |
| Medicare PECOS PAC ID | 3274554738 |
|---|---|
| Medicare Enrollment ID | O20051212000629 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376723478 | NPI | - | NPPES |
| 73683 | Other | FL | BLUE CROSS/BLUE SHIELD |
| 056610 | Other | FL | VALUE OPTIONS/TRICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY3726 (Florida) | Primary |
| Provider Name | Michael Fish |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548358294 PECOS PAC ID: 5991726457 Enrollment ID: I20051213000223 |
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