Basic Information
| Provider Information | |||||||||
| NPI: | 1225238892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UCHAL | ||||||||
| FirstName: | MIROSLAV | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11945 SAN JOSE BLVD | ||||||||
| Address2: | BLDG. 300 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322231627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043961725 | ||||||||
| FaxNumber: | 9043991717 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 SHIRCLIFF WAY | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322044763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043898861 | ||||||||
| FaxNumber: | 9043895820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 07/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD432283 | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2776465 | 05 | OH | MEDICAID | 8040398 | 01 | FL | CIGNA | OTHER | 1020048520001 | 05 | PA | MEDICAID | 14A28 | 01 | FL | BLUE CROSS BLUE SHIELD FL | OTHER | 3810009947 | 05 | WV | MEDICAID |