Provider Demographics
NPI:1952357303
Name:BURGOS, MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:BURGOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 FURLONG WAY
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-5118
Mailing Address - Country:US
Mailing Address - Phone:407-281-0470
Mailing Address - Fax:
Practice Address - Street 1:7824 LAKE UNDERHILL RD STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8201
Practice Address - Country:US
Practice Address - Phone:407-281-0470
Practice Address - Fax:407-273-1848
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373759100Medicaid
FLD95888Medicare UPIN
FL23580EMedicare PIN
FL23580XMedicare ID - Type Unspecified