Healthcare Provider Details

I. General information

NPI: 1376054098
Provider Name (Legal Business Name): MICHAEL FREDERICK AVILES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NW 36TH ST
MIAMI FL
33142-5559
US

IV. Provider business mailing address

9801 SW 148TH AVE
MIAMI FL
33196-1643
US

V. Phone/Fax

Practice location:
  • Phone: 786-378-8200
  • Fax:
Mailing address:
  • Phone: 786-319-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9431964
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: