Basic Information
| Provider Information | |||||||||
| NPI: | 1801864137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAHALSKY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | PRESTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., P.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ZAHALSKY | ||||||||
| OtherFirstName: | MICHAEL | ||||||||
| OtherMiddleName: | P | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD, PA | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5850 CORAL RIDGE DRIVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330761600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547148200 | ||||||||
| FaxNumber: | 9548402626 | ||||||||
| Practice Location | |||||||||
| Address1: | 5850 CORAL RIDGE DR | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330763378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547148200 | ||||||||
| FaxNumber: | 9548402626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2006 | ||||||||
| LastUpdateDate: | 12/23/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME93599 | FL | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 20-2763393 | 01 | FL | TAX ID # | OTHER | 2729687000 | 05 | FL | MEDICAID |