Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME118464 | FL |
NPI | 1245421361 |
---|---|
Provider Name | Miguel Angel Medina |
First Address | Atlanta, GA 30384-8054 |
Second Address | Miami, FL 33176-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 20/04/2021 |