Basic Information
| Provider Information | |||||||||
| NPI: | 1508062860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OZCAN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 CYPRESS GLEN CIR | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347417560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075181074 | ||||||||
| FaxNumber: | 4075189056 | ||||||||
| Practice Location | |||||||||
| Address1: | 1160 CYPRESS GLEN CIR | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347417560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075181074 | ||||||||
| FaxNumber: | 4075189056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME110396 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | TRN11754 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 003110994A | 05 | GA | MEDICAID | 14EW1 | 01 | FL | BCBSFL | OTHER | 003794200 | 05 | FL | MEDICAID |