Provider Demographics
NPI:1619170123
Name:GOROSTIAGA, FEDERICO (MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:
Last Name:GOROSTIAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FEDERICO
Other - Middle Name:
Other - Last Name:GOROSTIAGA RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8900 N KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2118
Mailing Address - Country:US
Mailing Address - Phone:786-596-6944
Mailing Address - Fax:
Practice Address - Street 1:8900 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2118
Practice Address - Country:US
Practice Address - Phone:786-596-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116039207RC0200X
MA230858207R00000X
CT045849208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009255300Medicaid
FL14RQ5OtherBCBS
FLME 116039OtherME LICENSE
FLME 116039OtherME LICENSE
MA3150864OtherCIGNA
MA221829Medicare Oscar/Certification
FLME 116039OtherME LICENSE
FL14RQ5OtherBCBS
1619170123OtherTUFTS
MA41445OtherHNE
FL009255300Medicaid
MAMG0672611AOtherCSR
MAM21172Medicare PIN