Healthcare Provider Details

I. General information

NPI: 1548910680
Provider Name (Legal Business Name): IVAN EDUARDO ESCALONA PUIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 NW 95TH ST
MIAMI FL
33147-2414
US

IV. Provider business mailing address

345 NW 44TH ST
MIAMI FL
33127-2652
US

V. Phone/Fax

Practice location:
  • Phone: 305-827-2977
  • Fax:
Mailing address:
  • Phone: 561-629-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number1548910680
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: