Individual
DR. MICHAEL PAUL WIDICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 W COCOA BEACH CSWY, SUITE B, COCOA BEACH, FL 32931-3513
(321) 799-9797
(321) 799-3393
Mailing address
333 W COCOA BEACH CSWY, SUITE B, COCOA BEACH, FL 32931-3513
(321) 799-9797
(321) 799-3393
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME0061454
FL
207YX0602X
Otolaryngic Allergy Physician
ME0061454
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263517800
—
FL
Enumeration date
07/13/2005
Last updated
02/27/2013
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