Healthcare Provider Details

I. General information

NPI: 1710198239
Provider Name (Legal Business Name): MIGUEL ANGEL CORREA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N 3RD ST
LEESBURG FL
34748-5105
US

IV. Provider business mailing address

4521 SW 159TH STREET RD
OCALA FL
34473-3578
US

V. Phone/Fax

Practice location:
  • Phone: 787-594-8079
  • Fax: 352-360-6582
Mailing address:
  • Phone: 787-594-8079
  • Fax: 352-360-6582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number13941
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberACN 603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: