Provider Demographics
NPI:1306814397
Name:JUAN, AXEL (MD)
Entity Type:Individual
Prefix:
First Name:AXEL
Middle Name:
Last Name:JUAN
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 1:2908 ROYAL PALM AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4341
Mailing Address - Country:US
Mailing Address - Phone:305-531-4178
Mailing Address - Fax:
Practice Address - Street 1:3898 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5503
Practice Address - Country:US
Practice Address - Phone:305-644-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH29803Medicare UPIN
FLE4971Medicare ID - Type Unspecified