Provider Demographics
NPI:1669541967
Name:MIAMI ONCOLOGY INSTITUTE PA
Entity type:Organization
Organization Name:MIAMI ONCOLOGY INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:ACLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-261-9293
Mailing Address - Street 1:747 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 503A
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2049
Mailing Address - Country:US
Mailing Address - Phone:305-261-9293
Mailing Address - Fax:305-446-6078
Practice Address - Street 1:747 PONCE DE LEON BLVD STE 503A
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2073
Practice Address - Country:US
Practice Address - Phone:305-261-9293
Practice Address - Fax:305-446-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31968207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
36-70005OtherUNITED HEALTHCARE
FL066025600Medicaid
208156OtherAVMED
224781OtherAMERIGROUP
995088OtherNEIGHBORHOOD
442315OtherMEDICA
00679OtherHEALTHSUN
10718OtherTOTAL HEALTH CHOICE
4994248OtherCIGNA
0027EOtherPREFERRED CARE
208156OtherAVMED
D63575Medicare UPIN
FL066025600Medicaid