Provider Demographics
NPI:1902217706
Name:PICHARDO, MILAGROS B (MD)
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:B
Last Name:PICHARDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 37TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6518
Mailing Address - Country:US
Mailing Address - Phone:772-567-4336
Mailing Address - Fax:772-567-4340
Practice Address - Street 1:1485 37TH ST STE 102
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6518
Practice Address - Country:US
Practice Address - Phone:772-567-4336
Practice Address - Fax:772-567-4340
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME145375207R00000X
MO2017031999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106587500Medicaid