Basic Information
| Provider Information | |||||||||
| NPI: | 1649606864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAINTER | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21000 NE 28TH AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331801421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059371999 | ||||||||
| FaxNumber: | 3059319741 | ||||||||
| Practice Location | |||||||||
| Address1: | 21000 NE 28TH AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331801421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059371999 | ||||||||
| FaxNumber: | 3059319741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2013 | ||||||||
| LastUpdateDate: | 04/13/2015 | ||||||||
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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 | 363A00000X | PAT9107496 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.