Provider Demographics
NPI:1487645149
Name:RANGEL, LUIS G (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:G
Last Name:RANGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:G
Other - Last Name:DIAZ-RANGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:777 E 25TH ST STE 118
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3804
Mailing Address - Country:US
Mailing Address - Phone:305-693-1988
Mailing Address - Fax:305-693-3941
Practice Address - Street 1:777 E 25TH ST STE 118
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3804
Practice Address - Country:US
Practice Address - Phone:305-693-1988
Practice Address - Fax:305-693-3941
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052014207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17703ZOtherGROUP MK
FL370890000Medicaid
FL370890000Medicaid
FL17703Medicare ID - Type Unspecified