Provider Demographics
NPI:1144069543
Name:LAVELANET, MICHAEL DANIEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DANIEL
Last Name:LAVELANET
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5654 NW 101ST DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2592
Mailing Address - Country:US
Mailing Address - Phone:954-806-3714
Mailing Address - Fax:
Practice Address - Street 1:3708 N OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6451
Practice Address - Country:US
Practice Address - Phone:954-909-4998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL91186072083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine