1528053089 NPI number — RUBEN A MIGUEL M.D.

Table of content: RUBEN A MIGUEL M.D. (NPI 1528053089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528053089 NPI number — RUBEN A MIGUEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIGUEL
Provider First Name:
RUBEN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1528053089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7575 NORTHCLIFF AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44144-3267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-398-8196
Provider Business Mailing Address Fax Number:
216-398-8192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7575 NORTHCLIFF AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44144-3267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-398-8196
Provider Business Practice Location Address Fax Number:
216-398-8192
Provider Enumeration Date:
09/12/2005

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: 207RR0500X , with the licence number:  35035000 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000030862 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P35000 . This is a "SUMMACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341847368035 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 105350 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000030862 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 393476 . This is a "WELLCARE OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0242759 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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