Provider Demographics
NPI:1164448072
Name:LORENTE, MIGUEL LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:LYNN
Last Name:LORENTE
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:PO BOX 120043
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32912-0043
Mailing Address - Country:US
Mailing Address - Phone:321-676-7860
Mailing Address - Fax:321-952-7224
Practice Address - Street 1:2107 DAIRY RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-5209
Practice Address - Country:US
Practice Address - Phone:321-676-7860
Practice Address - Fax:321-952-7224
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82880173000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262684500Medicaid
FL262684500Medicaid
FLH24300Medicare UPIN