Healthcare Provider Details

I. General information

NPI: 1013459221
Provider Name (Legal Business Name): JUAN MIGUEL DELGADO POLANCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUAN MIGUEL DELGADO

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9065 DADELAND BLVD
MIAMI FL
33156-7905
US

IV. Provider business mailing address

8600 NW 41ST ST
DORAL FL
33166-6202
US

V. Phone/Fax

Practice location:
  • Phone: 305-536-6479
  • Fax: 305-646-3286
Mailing address:
  • Phone: 305-642-5366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME161512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: