Basic Information
| Provider Information | |||||||||
| NPI: | 1467024836 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL P. ZAHALSKY, MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5850 CORAL RIDGE DR STE 106 | ||||||||
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| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330763379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547148200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 990 N FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330624318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547148200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2021 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | PELLETIER | ||||||||
| AuthorizedOfficialFirstName: | LEA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNT RECEIVABLE SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 9547148200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 001667402 | 05 | FL | MEDICAID |