Provider Demographics
NPI:1023109931
Name:LIGONDE-MERISIO, MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:LIGONDE-MERISIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LIGONDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:HOSPITAL METROPOLITANO DR PILA -PORRATA PILA
Mailing Address - Street 2:2445 AVE LAS AMERICAS SUITE 309
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:939-248-3534
Mailing Address - Fax:954-278-3534
Practice Address - Street 1:METROPAVIA HOSPITAL DR PILA
Practice Address - Street 2:2445 AVENIDA LAS AMERICAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:939-248-3534
Practice Address - Fax:954-278-8451
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19832207P00000X
PR14308-I208D00000X
FL9209369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003215800Medicaid
FLAE443ZMedicare PIN