Provider Demographics
NPI:1619940665
Name:TIRADO, AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:
Last Name:TIRADO
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:STE. 1006
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-856-8440
Practice Address - Fax:305-856-8735
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 45364208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3850777OtherCIGNA
FL001431OtherNHP
FL214067OtherAVMED
FLP01606324OtherRR MEDICARE
FL1431OtherDIMENSION
FLP1036029OtherFREEDOM
FL4072679OtherAETNA
FL96693OtherBLUE CROSS BLUE SHIELD
FL96693OtherBCBS
FLP971745OtherOPTIMUM
FL981693OtherWELLCARE
FLP0001583OtherSIMPLY
FL045320000Medicaid
FL214067OtherAVMED
FL981693OtherWELLCARE
FL045320000Medicaid