Provider Demographics
NPI:1851458640
Name:MARTINEZ, MIGUEL ELADIO (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ELADIO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1951 SW 172ND AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5593
Mailing Address - Country:US
Mailing Address - Phone:954-885-5030
Mailing Address - Fax:954-272-9026
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-885-5030
Practice Address - Fax:954-272-9026
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME40138207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371295800Medicaid
FL96320WMedicare UPIN
FLD64878Medicare UPIN