Provider Demographics
NPI:1174814842
Name:BADA, ALVARO MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:MIGUEL
Last Name:BADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18308 MURDOCK CIR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1025
Mailing Address - Country:US
Mailing Address - Phone:941-255-0069
Mailing Address - Fax:941-255-0072
Practice Address - Street 1:18308 MURDOCK CIR UNIT 101
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1025
Practice Address - Country:US
Practice Address - Phone:941-255-0069
Practice Address - Fax:941-255-0072
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129936208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IY8052OtherMEDICARE