Provider Demographics
NPI:1295723336
Name:MULET, MIGUEL E SR (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:E
Last Name:MULET
Suffix:SR
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 1:1840 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-2138
Mailing Address - Country:US
Mailing Address - Phone:727-442-3001
Mailing Address - Fax:727-467-9106
Practice Address - Street 1:1840 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-2138
Practice Address - Country:US
Practice Address - Phone:727-442-3001
Practice Address - Fax:727-467-9106
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0013730207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51059OtherBC FLORIDA
51059AMedicare ID - Type Unspecified
FL51059OtherBC FLORIDA