Provider Demographics
NPI:1558320887
Name:FELIZ, MIRIAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:A
Last Name:FELIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3487 NW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1103
Mailing Address - Country:US
Mailing Address - Phone:954-641-4200
Mailing Address - Fax:954-487-1807
Practice Address - Street 1:8850 NW 122ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:954-641-4200
Practice Address - Fax:954-487-1807
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43362208100000X
FLME0043362174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040295800Medicaid
FLD85642Medicare UPIN
FL36373Medicare ID - Type UnspecifiedPROVIDER ID