Provider Demographics
NPI:1154596146
Name:OSORIO, MERLIN IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:MERLIN
Middle Name:IVAN
Last Name:OSORIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 421953
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33242-1953
Mailing Address - Country:US
Mailing Address - Phone:786-663-0493
Mailing Address - Fax:305-200-0192
Practice Address - Street 1:1778 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2017
Practice Address - Country:US
Practice Address - Phone:786-663-0493
Practice Address - Fax:305-995-0448
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN512208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty