Provider Demographics
NPI:1932149457
Name:MIGUEL RIVERA MD PA
Entity Type:Organization
Organization Name:MIGUEL RIVERA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEGIROLAMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-751-6583
Mailing Address - Street 1:2043 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5223
Mailing Address - Country:US
Mailing Address - Phone:941-366-9450
Mailing Address - Fax:941-366-9459
Practice Address - Street 1:2043 ROSE ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5223
Practice Address - Country:US
Practice Address - Phone:941-366-9450
Practice Address - Fax:941-366-9459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME769522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264551300Medicaid
FL264551300Medicaid
FLE5036XMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLP00140037Medicare ID - Type UnspecifiedRAILROAD MEDICARE PROVIDE
FLH30760Medicare UPIN