Individual
DR. GENON MICHELLE WICINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2150 SE SALERNO RD, SUITE 116, STUART, FL 34997-6572
(772) 223-5777
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-5665
(772) 223-5646
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME0074465
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
253290500
—
FL
Enumeration date
07/30/2006
Last updated
10/13/2020
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