Basic Information
| Provider Information | |||||||||
| NPI: | 1437301645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIKHAIL | ||||||||
| FirstName: | MARYANN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 WASHINGTON AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331396639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052436704 | ||||||||
| FaxNumber: | 3052433503 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 WASHINGTON AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331396639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052436704 | ||||||||
| FaxNumber: | 3052433503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | ME141943 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 251813 | NY | N | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.