1710198239 NPI number — MR. MIGUEL ANGEL CORREA MD

Table of content: A. G. BHARATKUMAR M.D. (NPI 1689603425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710198239 NPI number — MR. MIGUEL ANGEL CORREA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORREA
Provider First Name:
MIGUEL
Provider Middle Name:
ANGEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710198239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4521 SW 159TH STREET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34473-3578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-594-8079
Provider Business Mailing Address Fax Number:
352-360-6582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 N 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34748-5105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-594-8079
Provider Business Practice Location Address Fax Number:
352-360-6582
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QA0401X , with the licence number:  13941 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: ACN 603 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 013891700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: IA462 . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 013891700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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