Healthcare Provider Details

I. General information

NPI: 1760411029
Provider Name (Legal Business Name): MIGUEL E TREVINO MD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 S. FT. HARRISON AVENUE
CLEARWATER FL
33756
US

IV. Provider business mailing address

1573 S FORT HARRISON AVE
CLEARWATER FL
33756-2004
US

V. Phone/Fax

Practice location:
  • Phone: 727-584-8777
  • Fax: 727-584-8772
Mailing address:
  • Phone: 727-584-8777
  • Fax: 727-584-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0048086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: