Basic Information
| Provider Information | |||||||||
| NPI: | 1831519909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRONIN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | HAWK | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 S HARBOR CITY BLVD STE 610 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329015591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217237716 | ||||||||
| FaxNumber: | 3217230604 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 S HARBOR CITY BLVD STE 610 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329015591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217237716 | ||||||||
| FaxNumber: | 3217230604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2014 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 167906 | OR | N | Allopathic & Osteopathic Physicians | General Practice | 207X00000X | OS15191 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 103232500 | 05 | FL | MEDICAID | OU414 | 01 | FL | HF MEDICARE | OTHER |