Provider Demographics
NPI:1073538138
Name:TABARO, MIGUEL ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANTONIO
Last Name:TABARO
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 1:13238 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1176
Mailing Address - Country:US
Mailing Address - Phone:305-552-9505
Mailing Address - Fax:305-552-9953
Practice Address - Street 1:13238 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1176
Practice Address - Country:US
Practice Address - Phone:305-552-9505
Practice Address - Fax:305-552-9953
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL70757208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG50845Medicare UPIN
FL45082AMedicare ID - Type UnspecifiedMEDICARE NUMBER