Provider Demographics
NPI:1720160864
Name:MIAMI GASTROENTEROLOGY CONSULTANTS, PA
Entity Type:Organization
Organization Name:MIAMI GASTROENTEROLOGY CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-274-7800
Mailing Address - Street 1:8525 SW 92 ST
Mailing Address - Street 2:SUITE C10
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156
Mailing Address - Country:US
Mailing Address - Phone:305-274-7800
Mailing Address - Fax:305-270-1246
Practice Address - Street 1:8525 SW 92 ST
Practice Address - Street 2:SUITE C10
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:305-274-7800
Practice Address - Fax:305-270-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254791100Medicaid
FL378851200Medicaid
FL055460000Medicaid
FL254332000Medicaid