Provider Demographics
NPI:1316948797
Name:MIGICOVSKY, BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:MIGICOVSKY
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 1:4700 SHERIDAN ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3420
Mailing Address - Country:US
Mailing Address - Phone:954-961-8400
Mailing Address - Fax:954-963-8508
Practice Address - Street 1:11011 SHERIDAN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33026-1505
Practice Address - Country:US
Practice Address - Phone:954-961-8400
Practice Address - Fax:954-961-8401
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47469207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046776600Medicaid
FL046776600Medicaid
FL02938XMedicare ID - Type UnspecifiedMEDICARE NUMBER