Provider Demographics
NPI:1639281025
Name:ESPIRITU, MIGUEL ATILLO (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ATILLO
Last Name:ESPIRITU
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 1:304 NE 19TH DR
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1911
Mailing Address - Country:US
Mailing Address - Phone:863-467-0533
Mailing Address - Fax:863-467-4303
Practice Address - Street 1:304 NE 19TH DR
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1911
Practice Address - Country:US
Practice Address - Phone:863-467-0533
Practice Address - Fax:863-467-4303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0028374207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180006811OtherRAILROAD MEDICARE
FL066680700Medicaid
FL47040OtherBCBS OF FLORIDA
FLME0028374OtherMEDICAL LICENSE NUMBER
FL0662450001Medicare NSC
FL47040OtherBCBS OF FLORIDA
D54993Medicare UPIN