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Organization
MIGUEL A MEDINA MD PA
Active
Organization
MIGUEL A MEDINA MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIGUEL ANGEL MEDINA MD (PHYSICIAN)
(321) 268-6111
Entity
Organization
Contact information
Practice address
119 S PARK AVE, TITUSVILLE, FL 32796-3377
(321) 264-8644
(321) 264-8933
Mailing address
119 S PARK AVE, TITUSVILLE, FL 32796-3377
(321) 264-8644
(321) 264-8933
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0097000
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME97000
STATE LICENSE
FL
Enumeration date
04/10/2008
Last updated
08/17/2009
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