Provider Demographics
NPI:1285623306
Name:MIKI, ROBERTO A (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:A
Last Name:MIKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERTO
Other - Middle Name:A
Other - Last Name:MIKI-YOSHIDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6930 TULIPAN CT
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6518
Mailing Address - Country:US
Mailing Address - Phone:305-733-2172
Mailing Address - Fax:305-663-1839
Practice Address - Street 1:1295 NW 14TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:305-243-5879
Practice Address - Fax:305-663-1839
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31857207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063278300Medicaid
FL063278300Medicaid
FL95497Medicare PIN