Individual
MAIKE TIEDE BLAYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1150 N 35TH AVE STE 590, HOLLYWOOD, FL 33021
(954) 265-9500
(954) 265-1431
Mailing address
2900 CORPORATE WAY, DOOR D, MIRAMAR, FL 33025-3925
(954) 276-5685
(954) 985-7074
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME124225
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014949100
—
FL
Enumeration date
06/05/2007
Last updated
03/12/2021
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