Provider Demographics
NPI:1730164062
Name:RUIZ-UNGER, JUAN MIQUEL (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MIQUEL
Last Name:RUIZ-UNGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2075
Mailing Address - Country:US
Mailing Address - Phone:305-554-6666
Mailing Address - Fax:
Practice Address - Street 1:8900 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2075
Practice Address - Country:US
Practice Address - Phone:305-554-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45343208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069764802Medicaid
FL069764800Medicaid
FL069764800Medicaid