Basic Information
| Provider Information | |||||||||
| NPI: | 1700887981 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | HOWARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6705 S RED RD | ||||||||
| Address2: | # 704 | ||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056660203 | ||||||||
| FaxNumber: | 7865331680 | ||||||||
| Practice Location | |||||||||
| Address1: | 6705 S RED RD | ||||||||
| Address2: | # 704 | ||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056660203 | ||||||||
| FaxNumber: | 7865331680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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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 | 207Y00000X | ME47631 | FL | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 376667500 | 05 | FL | MEDICAID |