Provider Demographics
NPI:1073502753
Name:MIDENCE, CARLOS ROBERTO SR (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ROBERTO
Last Name:MIDENCE
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:8700 SW 88TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2206
Mailing Address - Country:US
Mailing Address - Phone:305-271-1515
Mailing Address - Fax:305-271-1519
Practice Address - Street 1:8700 SW 88TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2206
Practice Address - Country:US
Practice Address - Phone:305-271-1515
Practice Address - Fax:305-271-1519
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2015-04-24
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Provider Licenses
StateLicense IDTaxonomies
FLME104315207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D95867Medicare UPIN
D95867Medicare UPIN