Healthcare Provider Details

I. General information

NPI: 1841346426
Provider Name (Legal Business Name): JUAN FERNANDO AGUDELO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JFK DR STE 100
ATLANTIS FL
33462-6641
US

IV. Provider business mailing address

180 JFK DR STE 100
ATLANTIS FL
33462-6641
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-6500
  • Fax: 561-423-4687
Mailing address:
  • Phone: 561-967-6500
  • Fax: 833-464-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number47348
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME107908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: