Provider Demographics
NPI:1689609026
Name:HERNANDEZ, MIGUEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:F
Last Name:HERNANDEZ
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 1:7824 SW 195TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8130
Mailing Address - Country:US
Mailing Address - Phone:305-541-4004
Mailing Address - Fax:
Practice Address - Street 1:1835 W FLAGLER ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1917
Practice Address - Country:US
Practice Address - Phone:305-541-4004
Practice Address - Fax:305-644-4988
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0084374208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259453600Medicaid
FL259453600Medicaid
FLU0388AMedicare ID - Type Unspecified