Miguel J Boque-Santiago, MD
Individual provider Active NPI Internal Medicine Physician · Tavares, FL
NPI 1891801247 · NPPES record last updated May 13, 2019
Key facts
- NPI
- 1891801247
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 14822 (PR)
- Practice address
- 1390 E Burleigh Blvd
Tavares, FL 32778-4305 - Phone
- (352) 530-1355
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180124003304 | FL | Practitioner - Internal Medicine | 9739180142 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Florida Inpatient Medicine LLC | Internal Medicine | Current |
Accepting new patients |
Locations
525 Technology Park
Ste 109
Lake Mary, FL 32746
Phone 4076472346 ext. 111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 14822 | PR | Yes |
Addresses
Primary practice location
1390 E Burleigh Blvd
Tavares, FL 32778-4305
Mailing address
525 Technology Park
Ste 109
Lake Mary, FL 32746-7107
Phone (407) 647-2346
Other names
- Dr. Miguel J Boque
Other providers in Tavares, FL
- Allison Beth Boemer
- Jessica Bogard
- Dan Argin Boggus
- Tamika S. Bolden
- Shalini Meera Boodram
- Borys a Mascarenhas MD PA
- Richard T Bosshardt
- Brittney Bowen
- Charles D. Bowers
- Elsie H Bowman
All providers in Tavares, FL · Internal Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.