MEDICARE: DR. IGNACIO CORO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	ME0041646	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083778641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IGNACIO CORO MD

Provider Business Mailing Address
First Line	:	9950 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3944
Country	:	US
Telephone Number	:	305-551-7340
Fax Number	:	305-226-6695

Provider Business Practice Location Address
First Line	:	9950 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3944
Country	:	US
Telephone Number	:	305-551-7340
Fax Number	:	305-226-6695

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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