Basic Information
Provider Information
NPI: 1063061257
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MIKHAIL
FirstName: MERIAM
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PSYD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4652 SAXON RD
Address2:  
City: COCONUT CREEK
State: FL
PostalCode: 330733532
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1881 N UNIVERSITY DR
Address2:  
City: CORAL SPRINGS
State: FL
PostalCode: 330718915
CountryCode: US
TelephoneNumber: 9543400888
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/10/2019
LastUpdateDate: 09/10/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X  Y Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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