Healthcare Provider Details

I. General information

NPI: 1407167430
Provider Name (Legal Business Name): MICHAEL G VALLADARES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 02/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 N KENDALL DRIVE SUITE 306
MIAMI FL
33176-1025
US

IV. Provider business mailing address

5101 SW 8TH STREET SUITE 200
CORAL GABLES FL
33134
US

V. Phone/Fax

Practice location:
  • Phone: 305-402-4563
  • Fax: 305-918-1077
Mailing address:
  • Phone: 305-359-5037
  • Fax: 786-509-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS11915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: