Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO1494 | FL |
Y | 222Z00000X | Podiatrist | PO1494 | FL |
NPI | 1053320135 |
---|---|
Provider Name | Miguel A Delage |
First Address | Miami, FL 33165-2075 |
Second Address | Miami, FL 33165-2075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2006 |
Last Update Date | 01/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041224400 | (05) | FL |
T55551 | (02) | FL |