Provider Demographics
NPI:1235207390
Name:DE LA ROSA, MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:DE LA ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MIGUEL
Other - Middle Name:
Other - Last Name:DE LA ROSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10621 N KENDALL DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8708
Mailing Address - Country:US
Mailing Address - Phone:305-969-9016
Mailing Address - Fax:305-971-0701
Practice Address - Street 1:10621 N KENDALL DR
Practice Address - Street 2:STE. 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8708
Practice Address - Country:US
Practice Address - Phone:305-969-9016
Practice Address - Fax:305-971-0701
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35597Medicare PIN
H20710Medicare UPIN