Provider Demographics
NPI:1205024510
Name:MANUEL SIVINA, M.D., P.A.
Entity Type:Organization
Organization Name:MANUEL SIVINA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-674-2760
Mailing Address - Street 1:4300 ALTON RD
Mailing Address - Street 2:SUITE 2240
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2800
Mailing Address - Country:US
Mailing Address - Phone:305-674-2760
Mailing Address - Fax:305-674-2769
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:SUITE 2240
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33140-2800
Practice Address - Country:US
Practice Address - Phone:305-674-2760
Practice Address - Fax:305-674-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00209902086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40330Medicare PIN