Healthcare Provider Details

I. General information

NPI: 1639167513
Provider Name (Legal Business Name): MIGUEL FLORES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 SW 117TH AVE STE 301
MIAMI FL
33183-4826
US

IV. Provider business mailing address

8200 SW 117TH AVE SUITE 301
MIAMI FL
33183-3856
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-1501
  • Fax: 305-279-1593
Mailing address:
  • Phone: 305-279-1501
  • Fax: 305-279-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME87988
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME87988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: