Provider Demographics
NPI:1902838733
Name:ALVAREZ, MIGUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:ALVAREZ
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 1:8340 LAKEWOOD RANCH BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202
Mailing Address - Country:US
Mailing Address - Phone:941-907-9751
Mailing Address - Fax:941-907-9554
Practice Address - Street 1:8340 LAKEWOOD RANCH BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-5180
Practice Address - Country:US
Practice Address - Phone:941-907-9751
Practice Address - Fax:941-907-9554
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52889208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050784900Medicaid
E60835Medicare UPIN