Provider Demographics
NPI:1558345595
Name:MITJANS, AURELIO (MD)
Entity Type:Individual
Prefix:
First Name:AURELIO
Middle Name:
Last Name:MITJANS
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 1:777 E 25TH ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3825
Mailing Address - Country:US
Mailing Address - Phone:305-836-1077
Mailing Address - Fax:305-836-5621
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:305-836-1077
Practice Address - Fax:305-836-5621
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26228174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27670Medicare UPIN