Provider Demographics
NPI:1811011588
Name:JUAN C QUEROL MD PA
Entity type:Organization
Organization Name:JUAN C QUEROL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MDPA
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:QUEROL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-698-0452
Mailing Address - Street 1:PO BOX 172286
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33017-2286
Mailing Address - Country:US
Mailing Address - Phone:305-698-0452
Mailing Address - Fax:305-698-0476
Practice Address - Street 1:5801 NW 151ST ST
Practice Address - Street 2:SUITE 306
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2476
Practice Address - Country:US
Practice Address - Phone:305-698-0452
Practice Address - Fax:305-698-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68841207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25031400Medicaid
FL25031400Medicaid