| Michael W Formisano Md Pa | |
|
4024 N Circle Dr Hollywood FL 33021-6726 | |
| (954) 989-4110 | |
| (954) 989-7855 |
| Full Name | Michael W Formisano Md Pa |
|---|---|
| Speciality | General Practice |
| Location | 4024 N Circle Dr, Hollywood, Florida |
| Authorized Official Name and Position | Michael W Formisano (PRESIDENT) |
| Authorized Official Contact | 9549894110 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael W Formisano Md Pa 3939 Hollywood Blvd Suite 2b Hollywood FL 33021-6749 Ph: (954) 989-4110 | Michael W Formisano Md Pa 4024 N Circle Dr Hollywood FL 33021-6726 Ph: (954) 989-4110 |
| NPI Number | 1639365158 |
|---|---|
| Provider Enumeration Date | 09/18/2007 |
| Last Update Date | 11/15/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639365158 | NPI | - | NPPES |
| ME 91614 | Other | FL | ME LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | ME 91614 (Florida) | Primary |
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