Provider Demographics
NPI:1982903589
Name:MIGUEL, TIAGO (MD)
Entity type:Individual
Prefix:DR
First Name:TIAGO
Middle Name:
Last Name:MIGUEL
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 1:100 S BEDFORD RD STE 340
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3444
Mailing Address - Country:US
Mailing Address - Phone:475-251-8856
Mailing Address - Fax:475-675-6054
Practice Address - Street 1:100 S BEDFORD RD STE 340
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3444
Practice Address - Country:US
Practice Address - Phone:475-251-8856
Practice Address - Fax:475-675-6054
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117449.207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHU831ZMedicare PIN