Healthcare Provider Details

I. General information

NPI: 1720074545
Provider Name (Legal Business Name): JUAN CARLOS ACEVEDO-CRESPO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 PONCE DE LEON BLVD SUITE 500
CORAL GABLES FL
33134-2049
US

IV. Provider business mailing address

8600 SW 92ND ST SUITE 204A
MIAMI FL
33156-7397
US

V. Phone/Fax

Practice location:
  • Phone: 305-648-1119
  • Fax: 305-648-1129
Mailing address:
  • Phone: 305-436-9933
  • Fax: 305-500-2137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME63849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: