Healthcare Provider Details

I. General information

NPI: 1891252201
Provider Name (Legal Business Name): AXEL MANUEL BAEZ-LUGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N FLAMINGO RD STE 204
PEMBROKE PINES FL
33028-1008
US

IV. Provider business mailing address

2900 CORPORATE WAY
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-276-3500
  • Fax: 954-385-6026
Mailing address:
  • Phone: 954-276-3500
  • Fax: 954-385-6026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME168392
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number168392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: