Provider Demographics
NPI:1962420828
Name:MAHLA, MICHAEL E (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:MAHLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:EDWARD
Other - Last Name:MAHLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1400 NW 10TH AVE STE 1104A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1000
Mailing Address - Country:US
Mailing Address - Phone:305-243-3828
Mailing Address - Fax:305-243-0143
Practice Address - Street 1:1400 NW 10TH AVE STE 1104A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1000
Practice Address - Country:US
Practice Address - Phone:305-243-3828
Practice Address - Fax:305-243-0143
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45109207L00000X
PAMD453812207L00000X
FLME151584207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046902500Medicaid
D57904Medicare UPIN
68443 ZMedicare PIN