Provider Demographics
NPI:1104453190
Name:MAMONE, MICHAEL VINCENT
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VINCENT
Last Name:MAMONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:FLORIDA ATLANTIC UNIVERSITY MEDICINE AT BOCA RATON
Mailing Address - Street 2:1001 NW 13TH STREET, STE. 201
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486
Mailing Address - Country:US
Mailing Address - Phone:561-955-6663
Mailing Address - Fax:561-955-2879
Practice Address - Street 1:2815 S SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7969
Practice Address - Country:US
Practice Address - Phone:561-292-4949
Practice Address - Fax:833-625-1623
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME163454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine