Healthcare Provider Details

I. General information

NPI: 1184797482
Provider Name (Legal Business Name): MIGUEL A DAVILA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E OAK ST
KISSIMMEE FL
34744-4503
US

IV. Provider business mailing address

7765 NW 48TH ST STE 300
DORAL FL
33166-5404
US

V. Phone/Fax

Practice location:
  • Phone: 407-988-1035
  • Fax: 407-988-1034
Mailing address:
  • Phone: 305-442-1740
  • Fax: 305-442-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15988
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN916
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberACN916
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: