Provider Demographics
NPI:1821097528
Name:BERASTAIN, MIGUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:BERASTAIN
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 1:7121 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4938
Mailing Address - Country:US
Mailing Address - Phone:361-994-5151
Mailing Address - Fax:
Practice Address - Street 1:7121 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 106
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4938
Practice Address - Country:US
Practice Address - Phone:361-994-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2317207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1831539Medicaid
B21206Medicare UPIN
TX00W571Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TX8F3095Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #