Provider Demographics
NPI:1295092799
Name:AURELIO MITJANS MD PA
Entity type:Organization
Organization Name:AURELIO MITJANS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AURELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MITJANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-836-1077
Mailing Address - Street 1:777 E 25TH ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3825
Mailing Address - Country:US
Mailing Address - Phone:305-836-1077
Mailing Address - Fax:
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:305-836-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26228174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067025100Medicaid
FL067025100Medicaid
FLD27670Medicare UPIN