Individual
JUAN PREMOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
21150 BISCAYNE BLVD, 404, AVENTURA, FL 33180-1226
(305) 466-9111
(305) 466-9127
Mailing address
2234 COLONIAL BLVD, MANAGED CARE DEPT, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME87618
FL
208800000X
Urology Physician
Primary
ME87618
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
240750
WELLCARE
FL
05
—
275037600
—
FL
01
—
7845484
AETNA PROVIDER #
FL
01
—
81710
BCBS FL
FL
01
—
P0003165
FLORIDA HEALTHCARE PLUS
FL
01
—
P00721043
RR MEDICARE PTAN
FL
01
—
P01720865
SIMPLY HEALTHCARE
FL
01
—
QMP000003854191
MOLINA
FL
Enumeration date
04/13/2006
Last updated
04/10/2017
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