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Organization
MICHAEL W FORMISANO MD PA
Active
Organization
MICHAEL W FORMISANO MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL W FORMISANO MD PA (PRESIDENT)
(954) 989-4110
Entity
Organization
Contact information
Practice address
4024 N CIRCLE DR, HOLLYWOOD, FL 33021-6726
(954) 989-4110
(954) 989-7855
Mailing address
3939 HOLLYWOOD BLVD, SUITE 2B, HOLLYWOOD, FL 33021-6749
(954) 989-4110
(954) 989-7855
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME 91614
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME 91614
ME LICENSE
FL
Enumeration date
09/18/2007
Last updated
11/15/2007
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