MEDICARE: JUAN M CUELLAR 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	207RN0300X	Nephrology Physician	ME87069	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00372284	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300893	OTHER	FL	AVMED
2	981883	OTHER	FL	COVENTRY HEALTH
3	5694080	OTHER	FL	FIRST HEALTH
4	2088546	OTHER	FL	CIGNA
5	56924	OTHER	FL	NHP
6	0186346	OTHER	FL	GHI PPO
7	7042817	OTHER	FL	AETNA
8	9456759	OTHER	FL	PHCS NETWORK

General Provider Information

NPI Number	:	1285617621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN M CUELLAR MD

Provider Business Mailing Address
First Line	:	219 NW 12TH AVE
Second Line	:	SUITE C5
City	:	MIAMI
State	:	FL
Zip	:	33128-2205
Country	:	US
Telephone Number	:	305-548-4063
Fax Number	:	305-545-1515

Provider Business Practice Location Address
First Line	:	219 NW 12TH AVE
Second Line	:	STE C5
City	:	MIAMI
State	:	FL
Zip	:	33128-2205
Country	:	US
Telephone Number	:	305-548-4063
Fax Number	:	305-545-1515

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	12/14/2022

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Directions to “ JUAN M CUELLAR MD” Practice Location

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