Healthcare Provider Details

I. General information

NPI: 1639281025
Provider Name (Legal Business Name): MIGUEL ATILLO ESPIRITU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 NE 19TH DR
OKEECHOBEE FL
34972-1911
US

IV. Provider business mailing address

304 NE 19TH DR
OKEECHOBEE FL
34972-1911
US

V. Phone/Fax

Practice location:
  • Phone: 863-467-0533
  • Fax: 863-467-4303
Mailing address:
  • Phone: 863-467-0533
  • Fax: 863-467-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME0028374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: