# MICHAEL MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629413463
- **Authorized official:** MICHAEL FORMISANO (PRESIDENT)
- **Authorized official phone:** (305) 381-5962

## Contact information

- **Practice address:** 4800 W FLAGLER ST STE 110, CORAL GABLES, FL 33134-1400
- **Practice address phone:** (305) 381-5962
- **Mailing address:** 4800 W FLAGLER ST STE 110, CORAL GABLES, FL 33134-1400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/07/2013
- **Last updated:** 05/07/2013