Provider Demographics
NPI:1619190402
Name:SIGFREDO ACOSTA PEREZ M.D. P.A.
Entity Type:Organization
Organization Name:SIGFREDO ACOSTA PEREZ M.D. P.A.
Other - Org Name:MERRITT ISLAND PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIGFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-452-3920
Mailing Address - Street 1:595 N COURTENAY PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4851
Mailing Address - Country:US
Mailing Address - Phone:321-452-3920
Mailing Address - Fax:321-459-1258
Practice Address - Street 1:595 N COURTENAY PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4851
Practice Address - Country:US
Practice Address - Phone:321-452-3920
Practice Address - Fax:321-459-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 64632208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0502937OtherCORESOURCE ID #
23749OtherBC-BS ID #
81083OtherCIGNA ID #
4348228OtherAETNA ID #
EM002 88779OtherHUMANA ACCOUNT #
4348228OtherAETNA ID #