Provider Demographics
NPI:1104898980
Name:GIVEN, MICHAEL J (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:GIVEN
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 1:322 RACETRACK RD NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2546
Mailing Address - Country:US
Mailing Address - Phone:850-863-3000
Mailing Address - Fax:850-374-3200
Practice Address - Street 1:322 RACETRACK RD NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2546
Practice Address - Country:US
Practice Address - Phone:850-863-3000
Practice Address - Fax:850-374-3200
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT180844-1205207RP1001X
MT70035207RP1001X
FLME0058957174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1104898980Medicaid
FL065229700Medicaid
FL065229700Medicaid
FL21279AMedicare ID - Type UnspecifiedGROUP #
FLE76165Medicare UPIN
FL252347700Medicaid
FL11686ZMedicare ID - Type UnspecifiedINDIVIDUAL PROV #