Provider Demographics
NPI:1538199005
Name:COSTA, MICHAEL E (LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:COSTA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9300 S DIXIE HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2935
Mailing Address - Country:US
Mailing Address - Phone:305-670-6696
Mailing Address - Fax:
Practice Address - Street 1:9300 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2935
Practice Address - Country:US
Practice Address - Phone:305-670-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11005171100000X
FLAP3512171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist