Provider Demographics
NPI:1295993954
Name:SERGIO XIQUES MD PA
Entity type:Organization
Organization Name:SERGIO XIQUES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:XIQUES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-225-8804
Mailing Address - Street 1:11760 SW 40TH ST
Mailing Address - Street 2:420
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3582
Mailing Address - Country:US
Mailing Address - Phone:305-225-8804
Mailing Address - Fax:305-225-4466
Practice Address - Street 1:11760 SW 40TH ST
Practice Address - Street 2:420
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-225-8804
Practice Address - Fax:305-225-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045708207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE31672Medicare UPIN
FL09460Medicare PIN