Provider Demographics
NPI:1730219718
Name:LOEFFLER, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LOEFFLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NE 36TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7574
Mailing Address - Country:US
Mailing Address - Phone:954-786-5353
Mailing Address - Fax:954-786-5340
Practice Address - Street 1:2100 NE 36TH ST STE 102
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7574
Practice Address - Country:US
Practice Address - Phone:954-786-5353
Practice Address - Fax:954-786-5340
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057699207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10462OtherBLUE CROSS BLUE SHIELD
FL180031877OtherRAILROAD MEDICARE
FL4312181OtherAETNA
FL3973732003OtherCIGNA
FL0870110OtherUNITED HEALTH CARE
FL3973732003OtherCIGNA
FL10462WMedicare PIN