MEDICARE: DR. OTTO L SECADA M.D.

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	207R00000X	Internal Medicine Physician	ME0060146	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	:	1942297205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OTTO L SECADA M.D.

Provider Business Mailing Address
First Line	:	7150 W 20TH AVE STE 209
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5531
Country	:	US
Telephone Number	:	305-828-5677
Fax Number	:	305-828-9196

Provider Business Practice Location Address
First Line	:	7150 W 20TH AVE STE 209
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5531
Country	:	US
Telephone Number	:	305-828-5677
Fax Number	:	305-828-9196

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	09/19/2022

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Directions to “ DR. OTTO L SECADA M.D.” Practice Location

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