Provider Demographics
NPI:1528079787
Name:RIVERA, MICHAEL A (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:A
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:8200 NW 27 ST
Mailing Address - Street 2:STE 108
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1906
Mailing Address - Country:US
Mailing Address - Phone:786-662-3893
Mailing Address - Fax:786-662-3899
Practice Address - Street 1:601 N FLAMINGO RD STE 414
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1012
Practice Address - Country:US
Practice Address - Phone:954-888-1444
Practice Address - Fax:954-392-5990
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2499213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390271400Medicaid
FLU51505Medicare UPIN
FL65403UMedicare PIN