Provider Demographics
NPI:1326032533
Name:MANUEL A OJEDA MD PA
Entity Type:Organization
Organization Name:MANUEL A OJEDA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:OJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-861-5196
Mailing Address - Street 1:4351 ROYAL PALM AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3018
Mailing Address - Country:US
Mailing Address - Phone:305-861-5196
Mailing Address - Fax:305-468-6258
Practice Address - Street 1:4351 ROYAL PALM AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3018
Practice Address - Country:US
Practice Address - Phone:305-861-5196
Practice Address - Fax:305-468-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263465101Medicaid
H58107Medicare UPIN
FL263465101Medicaid