Provider Demographics
NPI:1154300176
Name:HERNANDEZ, ANTONIO MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:MIGUEL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:8150 CHANCELLOR DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7691
Practice Address - Country:US
Practice Address - Phone:407-587-4243
Practice Address - Fax:407-251-5053
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2015-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME68082207ZP0102X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265412100Medicaid
FL47916ZMedicare PIN
FL47916XMedicare PIN
FLG22501Medicare UPIN
FL47916YMedicare PIN