Provider Demographics
NPI:1922096130
Name:XIQUES, SERGIO (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:XIQUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 SW 40TH ST
Mailing Address - Street 2:STE. 420
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3582
Mailing Address - Country:US
Mailing Address - Phone:305-225-8804
Mailing Address - Fax:305-225-4466
Practice Address - Street 1:11760 SW 40TH ST
Practice Address - Street 2:STE. 420
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-225-8804
Practice Address - Fax:305-225-4466
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0045708207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09460Medicare PIN
FLE31672Medicare UPIN