Provider Demographics
NPI:1215102173
Name:BINGLER, MICHAEL ABRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ABRAHAM
Last Name:BINGLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10140 CENTURION PARKWAY NORTH
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-5062
Mailing Address - Fax:904-697-5102
Practice Address - Street 1:13535 NEMOURS PKWY
Practice Address - Street 2:NEMOURS CHILDRENS HOSPITAL
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7402
Practice Address - Country:US
Practice Address - Phone:407-567-4000
Practice Address - Fax:407-567-5924
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME129317208000000X, 2080P0202X
PAMD4258712080P0202X
MO20090204392080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL'018839500Medicaid
FLIT045ZMedicare PIN