Provider Demographics
NPI:1952333775
Name:OJEDA, MANUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:OJEDA
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 1:4351 ROYAL PALM AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3018
Mailing Address - Country:US
Mailing Address - Phone:305-861-5196
Mailing Address - Fax:305-468-6258
Practice Address - Street 1:4351 ROYAL PALM AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3018
Practice Address - Country:US
Practice Address - Phone:305-861-5196
Practice Address - Fax:305-468-6258
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263465101Medicaid
FLE7223Medicare ID - Type Unspecified
H58107Medicare UPIN