Active NPI
Michel-Ange Edouard Destine
- Surgical Assistant
- Oakland Park, FL
National Provider Identifier
1255100061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 23-733
- Practice address
- 4513 NW 31St Ave
Oakland Park, FL 33309-3403 - Phone
- (202) 855-1545
- NPI assigned
- Dec 21, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 23-733 | FL | Primary |
Addresses
Primary practice location
4513 NW 31St Ave
Oakland Park, FL 33309-3403
Mailing address
4513 NW 31St Ave
Oakland Park, FL 33309-3403
Phone (202) 855-1545
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23-733 | FL | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703116800000",
"number": "1255100061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4513 NW 31ST AVE",
"city": "OAKLAND PARK",
"state": "FL",
"postal_code": "333093403",
"telephone_number": "202-855-1545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4513 NW 31ST AVE",
"city": "OAKLAND PARK",
"state": "FL",
"postal_code": "333093403",
"telephone_number": "202-855-1545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESTINE",
"first_name": "MICHEL-ANGE",
"middle_name": "EDOUARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-12-21",
"last_updated": "2023-12-21",
"certification_date": "2023-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "FL",
"license": "23-733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.