Provider Demographics
NPI:1962659599
Name:PRIETO, MISAEL ALBERTO (M D)
Entity type:Individual
Prefix:
First Name:MISAEL
Middle Name:ALBERTO
Last Name:PRIETO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15529 MIAMI LAKEWAY N
Mailing Address - Street 2:202
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5583
Mailing Address - Country:US
Mailing Address - Phone:305-821-3317
Mailing Address - Fax:
Practice Address - Street 1:15529 MIAMI LAKEWAY N
Practice Address - Street 2:202
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-5583
Practice Address - Country:US
Practice Address - Phone:305-821-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR017211207R00000X
FLME 103022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCR446ZMedicare PIN