Provider Demographics
NPI:1881650539
Name:ROSADA, MIGUEL A (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:ROSADA
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:PO BOX 44008
Mailing Address - Street 2:UFJP COMMUNITY HEALTH FAMILY MEDICINE
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-383-1900
Mailing Address - Fax:904-383-1901
Practice Address - Street 1:2485 MONUMENT RD
Practice Address - Street 2:SUITE 12
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3531
Practice Address - Country:US
Practice Address - Phone:904-383-1026
Practice Address - Fax:904-383-1901
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34436OtherMEDICARE GROUP #
FL34436OtherMEDICARE GROUP #
FL18317WMedicare PIN