Provider Demographics
NPI:1235152729
Name:OYARZUN, MIGUEL A (MD)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:OYARZUN
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 1:1435 W 49TH PL STE 703
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3158
Mailing Address - Country:US
Mailing Address - Phone:305-558-4411
Mailing Address - Fax:305-558-4611
Practice Address - Street 1:1140 W 50TH ST STE 207
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3438
Practice Address - Country:US
Practice Address - Phone:786-540-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FLME208882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055031100Medicaid
FL055031100Medicaid