Provider Demographics
NPI:1760411029
Name:TREVINO, MIGUEL E (MD PA)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:E
Last Name:TREVINO
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 S FORT HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2004
Mailing Address - Country:US
Mailing Address - Phone:727-584-8777
Mailing Address - Fax:727-584-8772
Practice Address - Street 1:1573 S. FT. HARRISON AVENUE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-584-8777
Practice Address - Fax:727-584-8772
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D21419Medicare UPIN