Provider Demographics
NPI:1689659096
Name:DENHAM, MISHA (DO)
Entity type:Individual
Prefix:DR
First Name:MISHA
Middle Name:
Last Name:DENHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2695 S LE JEUNE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5839
Mailing Address - Country:US
Mailing Address - Phone:305-672-8559
Mailing Address - Fax:305-672-9259
Practice Address - Street 1:2695 S LE JEUNE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5839
Practice Address - Country:US
Practice Address - Phone:305-672-8559
Practice Address - Fax:305-672-9259
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS9157207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003734400Medicaid
AG412YMedicare PIN