Basic Information
| Provider Information | |||||||||
| NPI: | 1902037468 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHELOV | ||||||||
| FirstName: | YEHUDA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 816759 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330810759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549642450 | ||||||||
| FaxNumber: | 9549646084 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 S STATE ROAD 7 STE 201 | ||||||||
| Address2: | |||||||||
| City: | MARGATE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330684033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7542296886 | ||||||||
| FaxNumber: | 7542296870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2009 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 272976 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 2884 | WV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | OS13567 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.