Provider Demographics
NPI:1942360771
Name:KOSCHIL, MIGUEL (PHD)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:KOSCHIL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 W FLAGLER ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1046
Mailing Address - Country:US
Mailing Address - Phone:786-545-6754
Mailing Address - Fax:305-397-1650
Practice Address - Street 1:2650 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137
Practice Address - Country:US
Practice Address - Phone:305-741-5628
Practice Address - Fax:305-397-1650
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW103371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty