Provider Demographics
NPI:1689054348
Name:DEREZIL, MICHAL-ANN (MD)
Entity type:Individual
Prefix:
First Name:MICHAL-ANN
Middle Name:
Last Name:DEREZIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N FLAGLER DR STE 430
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3430
Mailing Address - Country:US
Mailing Address - Phone:561-659-6336
Mailing Address - Fax:561-659-9327
Practice Address - Street 1:1025 MILITARY TRL STE 107
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7040
Practice Address - Country:US
Practice Address - Phone:561-659-6336
Practice Address - Fax:561-659-9327
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151337207R00000X, 207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine