Provider Demographics
NPI:1457410920
Name:LOPEZ-VIEGO, MIGUEL ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:LOPEZ-VIEGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MIGUEL
Other - Middle Name:ANGEL
Other - Last Name:LOPEZ-VIEGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2800 S SEACREST BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7960
Mailing Address - Country:US
Mailing Address - Phone:561-736-8200
Mailing Address - Fax:561-853-1608
Practice Address - Street 1:2800 S SEACREST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7960
Practice Address - Country:US
Practice Address - Phone:561-736-8200
Practice Address - Fax:561-853-1608
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME622942086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15251OtherBLUE CROSS BLUE SHIELD
FL371065300Medicaid
FLE04448Medicare UPIN
FL15251OtherBLUE CROSS BLUE SHIELD