Provider Demographics
NPI:1962749564
Name:IHOSVANI MIGUEL MD PA
Entity type:Organization
Organization Name:IHOSVANI MIGUEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IHOSVANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-290-1764
Mailing Address - Street 1:618 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-4649
Mailing Address - Country:US
Mailing Address - Phone:786-290-1764
Mailing Address - Fax:
Practice Address - Street 1:4258 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4108
Practice Address - Country:US
Practice Address - Phone:305-512-9002
Practice Address - Fax:305-512-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty