Provider Demographics
NPI:1902012339
Name:MIGUEL A TIRADO MD PLLC
Entity Type:Organization
Organization Name:MIGUEL A TIRADO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TIRADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-967-0330
Mailing Address - Street 1:305 SEGUINE AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3730
Mailing Address - Country:US
Mailing Address - Phone:718-967-0330
Mailing Address - Fax:
Practice Address - Street 1:305 SEGUINE AVE
Practice Address - Street 2:STE 1
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3730
Practice Address - Country:US
Practice Address - Phone:718-967-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty