Provider Demographics
NPI:1356430888
Name:DEROUIN, MICHAEL (DPM,FACFAS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DEROUIN
Suffix:
Gender:M
Credentials:DPM,FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 N ROOSEVELT BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3930
Mailing Address - Country:US
Mailing Address - Phone:305-294-5553
Mailing Address - Fax:305-294-6670
Practice Address - Street 1:2780 N ROOSEVELT BLVD STE 2
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3930
Practice Address - Country:US
Practice Address - Phone:305-294-5553
Practice Address - Fax:305-294-6670
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-000950213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340211800Medicaid
FL03012ZMedicare PIN
FL340211800Medicaid
FL1148440001Medicare NSC