Provider Demographics
NPI:1720230576
Name:MIGUEL A OYARZUN MD PA
Entity Type:Organization
Organization Name:MIGUEL A OYARZUN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:OYARZUN
Authorized Official - Suffix:
Authorized Official - Credentials:INTERNAL MEDICINE/MD
Authorized Official - Phone:305-558-4411
Mailing Address - Street 1:4890 W 2ND LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4363
Mailing Address - Country:US
Mailing Address - Phone:305-558-4411
Mailing Address - Fax:305-558-4611
Practice Address - Street 1:4890 W 2 LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-558-4411
Practice Address - Fax:305-558-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0020882282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055031100Medicaid
FL055031100Medicaid