Michael W Formisano MD PA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ME 91614 Issued in FL

Legal business name

MICHAEL W FORMISANO MD PA

Practice address

4024 N Circle Dr
Hollywood, FL 33021-6726

Phone

(954) 989-4110

Fax

(954) 989-7855

NPI assigned

Sep 18, 2007

Last updated

Nov 15, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael W Formisano, MD PA

Title

President

Phone

(954) 989-4110

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195084800000",
    "number": "1639365158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3939 HOLLYWOOD BLVD",
            "address_2": "SUITE 2B",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330216749",
            "telephone_number": "954-989-4110",
            "fax_number": "954-989-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4024 N CIRCLE DR",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330216726",
            "telephone_number": "954-989-4110",
            "fax_number": "954-989-7855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL W FORMISANO MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2007-11-15",
        "status": "A",
        "authorized_official_last_name": "FORMISANO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-989-4110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD PA"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME 91614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ME LICENSE",
            "identifier": "ME 91614",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lesli Michaud, COTA
• Marie Juline Michel, MD
• Lisa Micheletti, LMHC
• Midday Services Inc
• Deborah Lynn Middleton, CRT

• General Practice Physician in Hollywood, FL
• Providers in Hollywood, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.