Provider Demographics
NPI:1104010875
Name:MIGUEL A LOPEZ-VIEGO MD PA
Entity Type:Organization
Organization Name:MIGUEL A LOPEZ-VIEGO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:LOPEZ-VIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-736-8200
Mailing Address - Street 1:2800 SEACREST BOULEVARD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435
Mailing Address - Country:US
Mailing Address - Phone:561-736-8200
Mailing Address - Fax:561-853-1608
Practice Address - Street 1:2800 SOUTH SEACREST BOULEVARD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435
Practice Address - Country:US
Practice Address - Phone:561-736-8200
Practice Address - Fax:561-853-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3412Medicare PIN
FLE04448Medicare UPIN