Basic Information
| Provider Information | |||||||||
| NPI: | 1174868855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IYAMU | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8650 SW 212TH ST | ||||||||
| Address2: | APT. 303 | ||||||||
| City: | CUTLER BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331893757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326612385 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7031 SW 62ND AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052847761 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | UO3406 | FL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.