Provider Demographics
NPI:1700149143
Name:MIELES, ORLANDO ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:ENRIQUE
Last Name:MIELES
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 1:500 VONDERBURG DR STE 305
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5976
Mailing Address - Country:US
Mailing Address - Phone:813-651-0005
Mailing Address - Fax:813-902-7234
Practice Address - Street 1:500 VONDERBURG DR STE 305
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5976
Practice Address - Country:US
Practice Address - Phone:813-651-0005
Practice Address - Fax:813-902-7234
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18847208D00000X
FLACN628208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014928700Medicaid
FLIW107ZMedicare PIN