Individual provider Active NPI

Michael Bolanos, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Fort Lauderdale, FL
National Provider Identifier
1063708600
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
ME139818 Issued in FL
Practice address
1625 SE 3Rd Ave Ste 300
Fort Lauderdale, FL 33316-2521
Phone
(954) 355-4665
Fax
(954) 355-4881
NPI assigned
Jun 22, 2011
Last updated
Oct 20, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X ME139818 FL Primary

Addresses

Primary practice location

1625 SE 3Rd Ave Ste 300
Fort Lauderdale, FL 33316-2521

Mailing address

1608 SE 3Rd Ave FL 3
Fort Lauderdale, FL 33316-2564
Phone (954) 355-4665

Other practice location 1

1625 SE 3rd Ave Ste 355
Fort Lauderdale, FL 33316-2521
Phone (954) 355-5001

Other identifiers 3

IdentifierTypeStateIssuer
103651500MedicaidFL
Q01047319OtherFLMEDICARE RR
UP666OtherFLMEDICARE HF

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190621000361 FL Practitioner - Thoracic SurgeryPractitioner - Cardiac Surgery 6103134259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic SurgeryAlso: Cardiac Surgery
Education
Ponce School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Broward Hospital DistrictGroup PAC ID 3577472422, 192 clinicians

Practice addresses (Care Compare)

1625 SE 3 Ave
Fort Lauderdale, FL 33316-2521
Phone (954) 320-3322

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME139818FLMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Broward Hospital District CurrentSince Jun 2, 2025 Accepting new patients
North Broward Hospital District CurrentSince Jun 2, 2025 Accepting new patients
North Broward Hospital District Current Accepting new patients
North Broward Hospital District Past Accepting new patients
Thoracic & Cardiovascular Surgeons LLC Thoracic Surgery (Cardiothoracic Vascular Surgery) Past Accepting new patients
North Broward Hospital District Thoracic Surgery (Cardiothoracic Vascular Surgery) Past Accepting new patients

Locations

1625 SE 3rd Ave
Ste 355
Fort Lauderdale, FL 33316
Phone (954) 355-5001

1600 S Andrews Ave
Ft Lauderdale, FL 33316
Phone (954) 355-4000

1608 SE 3rd Ave
Fl 3
Ft Lauderdale, FL 33316

1625 SE 3rd Ave
Ste 300
Ft Lauderdale, FL 33316
Phone (954) 355-4665

1625 SE 3rd Ave
Ste 623
Ft Lauderdale, FL 33316
Phone (954) 320-3322

Networks

  • Freedom Health HMO Network

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760918400000",
    "number": "1063708600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1608 SE 3RD AVE FL 3",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162564",
            "telephone_number": "954-355-4665",
            "fax_number": "954-355-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SE 3RD AVE STE 300",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162521",
            "telephone_number": "954-355-4665",
            "fax_number": "954-355-4881"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1625 SE 3rd Ave Ste 355",
            "address_purpose": "LOCATION",
            "city": "Fort Lauderdale",
            "state": "FL",
            "postal_code": "333162521",
            "country_code": "US",
            "telephone_number": "954-355-5001",
            "fax_number": "954-355-4881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLANOS",
        "first_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-22",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "FL",
            "license": "ME139818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103651500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "Q01047319",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE HF",
            "identifier": "UP666",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.