Provider Demographics
NPI:1275731622
Name:MEIER DAVILA, MIRKO ALFREDO (MD)
Entity Type:Individual
Prefix:MR
First Name:MIRKO
Middle Name:ALFREDO
Last Name:MEIER DAVILA
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 1:7857 N. UNIVERSITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067
Mailing Address - Country:US
Mailing Address - Phone:954-518-7000
Mailing Address - Fax:954-518-7049
Practice Address - Street 1:7857 N. UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067
Practice Address - Country:US
Practice Address - Phone:954-518-7000
Practice Address - Fax:954-518-7049
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51999207Q00000X
FLME123357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MNENROLLEDMedicaid