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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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