Provider Demographics
NPI:1316995129
Name:MADARIAGA, MIGUEL G (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:G
Last Name:MADARIAGA
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 1:800 GOODLETTE RD N STE 370
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5448
Mailing Address - Country:US
Mailing Address - Phone:239-624-0800
Mailing Address - Fax:239-643-9062
Practice Address - Street 1:800 GOODLETTE RD N STE 370
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5448
Practice Address - Country:US
Practice Address - Phone:239-624-0800
Practice Address - Fax:239-643-9062
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436450207RI0200X
NE22402207RI0200X
FLME116589207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHK072ZOtherMEDICARE
FL009636600Medicaid
FL14R2GOtherBCBS