Provider Demographics
NPI:1437148384
Name:JIMENEZ, MILTON A (MD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:A
Last Name:JIMENEZ
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 1:12973 SW 112TH ST STE 224
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4768
Mailing Address - Country:US
Mailing Address - Phone:305-234-3408
Mailing Address - Fax:305-255-1752
Practice Address - Street 1:12002 SW 128TH CT STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4643
Practice Address - Country:US
Practice Address - Phone:305-234-3408
Practice Address - Fax:305-255-1752
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260910000Medicaid
FLE2932Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLH02230Medicare UPIN