Provider Demographics
NPI:1265472468
Name:LACAYO, MYRIAM D (MD)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:D
Last Name:LACAYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 SW 74TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2601
Mailing Address - Country:US
Mailing Address - Phone:786-281-7505
Mailing Address - Fax:305-595-8716
Practice Address - Street 1:10250 SW 56TH ST STE C101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7065
Practice Address - Country:US
Practice Address - Phone:786-558-8901
Practice Address - Fax:305-558-8917
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69826174400000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28353SMedicare ID - Type Unspecified
FLG26410Medicare UPIN
FL28353QMedicare PIN