Healthcare Provider Details

I. General information

NPI: 1730370768
Provider Name (Legal Business Name): JOSE MIGUEL SIMON CANELLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 W FLAGLER ST STE 420
MIAMI FL
33174-2546
US

IV. Provider business mailing address

PO BOX 831975
MIAMI FL
33283-1975
US

V. Phone/Fax

Practice location:
  • Phone: 305-608-0656
  • Fax: 786-254-7084
Mailing address:
  • Phone: 305-608-0656
  • Fax: 786-254-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberME112149
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME112149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: