Provider Demographics
NPI:1003162561
Name:VENEREO, MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:VENEREO
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 1:14700 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3416
Mailing Address - Country:US
Mailing Address - Phone:954-980-6626
Mailing Address - Fax:964-680-1529
Practice Address - Street 1:14700 SUNSET LN
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33330-3416
Practice Address - Country:US
Practice Address - Phone:954-980-6626
Practice Address - Fax:964-680-1529
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44851207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035100800Medicaid
FL035100800Medicaid