Provider Demographics
NPI:1285617621
Name:CUELLAR, JUAN M (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:219 NW 12TH AVE
Mailing Address - Street 2:SUITE C5
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-2205
Mailing Address - Country:US
Mailing Address - Phone:305-548-4063
Mailing Address - Fax:305-545-1515
Practice Address - Street 1:219 NW 12TH AVE
Practice Address - Street 2:STE C5
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-2205
Practice Address - Country:US
Practice Address - Phone:305-548-4063
Practice Address - Fax:305-545-1515
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2022-12-14
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Provider Licenses
StateLicense IDTaxonomies
FLME87069207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300893OtherAVMED
FL981883OtherCOVENTRY HEALTH
FL5694080OtherFIRST HEALTH
FL2088546OtherCIGNA
FL56924OtherNHP
FL0186346OtherGHI PPO
FL7042817OtherAETNA
FL9456759OtherPHCS NETWORK
FLP00372284OtherRAILROAD MEDICARE
FLU0691Medicare PIN