Provider Demographics
NPI:1568497949
Name:PALACIOS-MERCADO, MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:PALACIOS-MERCADO
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:PO BOX 5549
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-5549
Mailing Address - Country:US
Mailing Address - Phone:787-743-1415
Mailing Address - Fax:787-961-4609
Practice Address - Street 1:HIMA PLAZA 1
Practice Address - Street 2:500 AVE. DEGETAU, STE. 415
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-7301
Practice Address - Country:US
Practice Address - Phone:787-743-1415
Practice Address - Fax:787-961-4609
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
660580610OtherPREFERRED MEDICARE CHOICE
6250094OtherHUMANA INSURANCE
660580610OtherSALUD PORADICON MEDICARE
90414OtherSSS
27643OtherMEDICARE OPTIMO
660580610OtherAARP
660580610OtherCOSVIMED
68486OtherCRUZ AZUL
90414OtherMEDICARE OPTIMO
27643OtherSSS
6250094OtherHUMANA HEALTH PLANS
660580610OtherTRICARE
110074865OtherPALMETTO GBA RR MEDICARE
660580610OtherMEDICAL CARD SYSTEM
660580610OtherCIGNA
660580610OtherMCS CLASSICARE
660580610OtherPREFERRED MEDICARE CHOICE
90414OtherMEDICARE OPTIMO