Provider Demographics
NPI:1578518098
Name:MICHELEN NAMNUN, EDUARDO A (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:A
Last Name:MICHELEN NAMNUN
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:PMB 121 PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-256-2990
Mailing Address - Fax:
Practice Address - Street 1:URB LOIZA VALLEY
Practice Address - Street 2:A48 CALLE ORQUIDEA
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-256-2990
Practice Address - Fax:787-886-4603
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHQ894ZMedicaid
PR10271OtherPR MEDICAL LICENSE