Provider Demographics
NPI:1245216522
Name:MELENDEZ MUNOZ, MIGUEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:J
Last Name:MELENDEZ MUNOZ
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 1:1400 N SEMORAN BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3562
Mailing Address - Country:US
Mailing Address - Phone:407-823-8421
Mailing Address - Fax:407-823-8195
Practice Address - Street 1:719 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4580
Practice Address - Country:US
Practice Address - Phone:407-846-0533
Practice Address - Fax:407-518-1730
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME140764208D00000X
PR14375208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME140764OtherLICENSE
FLACN816OtherLICENSE
PR0021410Medicare ID - Type Unspecified