Provider Demographics
NPI:1790733426
Name:NAVAS MICHEO, MANUEL ANGEL (MD, FACOG)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANGEL
Last Name:NAVAS MICHEO
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HARRISON STREET
Mailing Address - Street 2:PHN OFFICE
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:321-268-6273
Practice Address - Street 1:250 HARRISON ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5094
Practice Address - Country:US
Practice Address - Phone:321-268-6868
Practice Address - Fax:321-268-4922
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8463207VX0000X
FLME147286207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660545671-6OtherMCS
PR6610095OtherHUMANA
PR2971OtherSSS
PR6610095OtherHUMANA