Basic Information
| Provider Information | |||||||||
| NPI: | 1053559757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORONA OLIVARES | ||||||||
| FirstName: | MIGUEL | ||||||||
| MiddleName: | JOEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11501 SW 40TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331653313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056463716 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7950 NW 2ND ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331268017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056425366 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2009 | ||||||||
| LastUpdateDate: | 09/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME108311 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | ME108311 | 01 | FL | FL DEPT OF HEALTH- BOARD OF MEDICINE | OTHER |