Provider Demographics
NPI:1740226190
Name:GONZALEZ, MANUEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:M
Last Name:GONZALEZ
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 1:15921 SW 254TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031-2045
Mailing Address - Country:US
Mailing Address - Phone:305-781-9881
Mailing Address - Fax:
Practice Address - Street 1:7921 BIRD RD STE 39
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6747
Practice Address - Country:US
Practice Address - Phone:786-310-1570
Practice Address - Fax:786-364-1400
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83670207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264849100OtherPSN
FL51993OtherBLUE CROSS BLUE SHIELD
FLN210329OtherWELLCARE
FL120577500Medicaid
FL264849100OtherPSN