Provider Demographics
NPI:1447343033
Name:DETWEILER, MICHELLE D (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:D
Last Name:DETWEILER
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 NW 27 ST
Mailing Address - Street 2:STE 108
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1902
Mailing Address - Country:US
Mailing Address - Phone:786-662-3893
Mailing Address - Fax:786-662-3899
Practice Address - Street 1:8280 NW 27 ST
Practice Address - Street 2:SUITE 505
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1905
Practice Address - Country:US
Practice Address - Phone:305-673-0033
Practice Address - Fax:305-673-9259
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2403213ES0103X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390635100Medicaid
FL65344Medicare ID - Type Unspecified
FLU35304Medicare UPIN