Individual
MIGUEL PORTOCARRERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1101 N CENTRAL AVE, KISSIMMEE, FL 34741-4405
(407) 933-2210
(407) 933-6428
Mailing address
3885 OAKWATER CIR, ORLANDO, FL 32806-6257
(407) 816-5700
(407) 812-6766
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME100657
FL
207RN0300X
Nephrology Physician
Primary
ME100657
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000204400
—
FL
01
—
59-1561574
TAX ID
FL
Enumeration date
02/22/2007
Last updated
11/07/2022
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