Provider Demographics
NPI:1740665942
Name:MIGUEL MED GROUP LLC
Entity type:Organization
Organization Name:MIGUEL MED GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:RODRIGUEZ MAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-277-1865
Mailing Address - Street 1:2324 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4916
Mailing Address - Country:US
Mailing Address - Phone:786-277-1865
Mailing Address - Fax:
Practice Address - Street 1:2324 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4916
Practice Address - Country:US
Practice Address - Phone:786-277-1865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49132261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center