Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A167633 | CA |
N | 207X00000X | Orthopaedic Surgeon | ME148978 | FL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A167633 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME148978 | FL |
NPI | 1134415664 |
---|---|
Provider Name | Dr. Michael R. Mijares |
First Address | Miami, FL 33176-2227 |
Second Address | Miami, FL 33176-2166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 31/08/2021 |