Provider Demographics
NPI:1316932528
Name:GORDON, MICHAEL H (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:GORDON
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 1:2001 NE 48TH CT
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4512
Mailing Address - Country:US
Mailing Address - Phone:954-772-0115
Mailing Address - Fax:954-772-1216
Practice Address - Street 1:2001 NE 48TH CT
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4512
Practice Address - Country:US
Practice Address - Phone:954-772-0115
Practice Address - Fax:954-772-1216
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014450207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AG5976406OtherDEA
D65794Medicare UPIN
FL78049Medicare ID - Type Unspecified