Individual
MIGUEL A MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 W COCOA BEACH CSWY, COCOA BEACH, FL 32931
(321) 868-5871
(321) 868-5852
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
ME97000
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281177400
—
FL
01
—
AC467W
MEDICARE
FL
Enumeration date
09/24/2006
Last updated
04/04/2019
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