Provider Demographics
NPI:1699213777
Name:SUEIRO, MARTIN JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JESUS
Last Name:SUEIRO
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 1:1400 NW 107TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2746
Mailing Address - Country:US
Mailing Address - Phone:305-534-0076
Mailing Address - Fax:305-631-2806
Practice Address - Street 1:11200 W FLAGLER STREET
Practice Address - Street 2:SUITES 101-107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4210
Practice Address - Country:US
Practice Address - Phone:305-370-3838
Practice Address - Fax:305-220-3466
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151646208D00000X
FLACN969208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104368100Medicaid
FLN5593OtherMEDICARE