Provider Demographics
NPI:1912993577
Name:DIVO, MIGUEL JOSE (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:JOSE
Last Name:DIVO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:PULMONARY DIVISION BRIGHAM AND WOMEN'S HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:857-307-0310
Mailing Address - Fax:617-582-6011
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:PULMONARY DIVISION BRIGHAM AND WOMEN'S HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:857-307-0310
Practice Address - Fax:617-582-6011
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-06-07
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Provider Licenses
StateLicense IDTaxonomies
MA205529207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2617610Medicaid
H92678Medicare UPIN
MA2617610Medicaid