Basic Information
Provider Information
NPI: 1780806190
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLORIN
FirstName: MICHAEL
MiddleName: CHARLES
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7301 OHMS LANE
Address2: EPPA, SUITE 650
City: EDINA
State: MN
PostalCode: 554394000
CountryCode: US
TelephoneNumber: 9528359880
FaxNumber:  
Practice Location
Address1: 28050 GRAND RIVER AVE
Address2:  
City: FARMINGTON HILLS
State: MI
PostalCode: 483365919
CountryCode: US
TelephoneNumber: 2484718224
FaxNumber: 2484718837
Other Information
ProviderEnumerationDate: 05/03/2007
LastUpdateDate: 07/22/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X5101016116MIY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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