Provider Demographics
NPI:1356706550
Name:SERIGADO SOARES DA COSTA, JOAO MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:JOAO MIGUEL
Middle Name:
Last Name:SERIGADO SOARES DA COSTA
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 1:200 SE HOSPITAL AVE # 2346
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2346
Mailing Address - Country:US
Mailing Address - Phone:772-287-5200
Mailing Address - Fax:
Practice Address - Street 1:200 SE HOSPITAL AVE # 2346
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2346
Practice Address - Country:US
Practice Address - Phone:772-287-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT055274207R00000X
FLME134565207R00000X, 207RG0100X
390200000X
NMMD2020-0357390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program