Provider Demographics
NPI:1851331227
Name:OVIEDO, RAIDEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAIDEL
Middle Name:
Last Name:OVIEDO
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 1:8600 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6202
Mailing Address - Country:US
Mailing Address - Phone:305-642-5366
Mailing Address - Fax:305-631-3803
Practice Address - Street 1:2901 NW 17TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-6631
Practice Address - Country:US
Practice Address - Phone:305-633-3015
Practice Address - Fax:305-634-9118
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270978300Medicaid
FLU3467Medicare ID - Type UnspecifiedRAIDEL OVIEDO MD
FLI18307Medicare UPIN