Healthcare Provider Details

I. General information

NPI: 1629226840
Provider Name (Legal Business Name): MIGUEL ALEXANDRE SANTOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

655 WATKINS MILL RD
GAITHERSBURG MD
20879-3301
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6973
  • Fax:
Mailing address:
  • Phone: 305-585-6973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0075892
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: