Provider Demographics
NPI:1861082687
Name:SOLNIK, MIKE (MD)
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:SOLNIK
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 1:400 SE 5TH AVE APT 503N
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5618
Mailing Address - Country:US
Mailing Address - Phone:561-212-9911
Mailing Address - Fax:
Practice Address - Street 1:400 SE 5TH AVE APT 503N
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5618
Practice Address - Country:US
Practice Address - Phone:561-212-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36897302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization