Provider Demographics
NPI:1982914321
Name:ANGEL F VIDAL MD PA
Entity Type:Organization
Organization Name:ANGEL F VIDAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-552-7020
Mailing Address - Street 1:11880 BIRD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-552-7020
Mailing Address - Fax:305-552-7006
Practice Address - Street 1:11880 BIRD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3584
Practice Address - Country:US
Practice Address - Phone:305-552-7020
Practice Address - Fax:305-552-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059197100Medicaid
FL78983BMedicare PIN
FL059197100Medicaid