Provider Demographics
NPI:1366487514
Name:MEDRANO, MILES (MD)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:MEDRANO
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 1:5401 S CONGRESS AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6637
Mailing Address - Country:US
Mailing Address - Phone:561-964-8221
Mailing Address - Fax:561-964-7393
Practice Address - Street 1:5401 S CONGRESS AVE
Practice Address - Street 2:#211
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6635
Practice Address - Country:US
Practice Address - Phone:561-964-8221
Practice Address - Fax:561-964-7393
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90022207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27089900Medicaid
FL27089900Medicaid
FL48124Medicare PIN