Basic Information
| Provider Information | |||||||||
| NPI: | 1124201538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JUAN A LOPETEGUI MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15680 N KENDALL DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331961159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054369933 | ||||||||
| FaxNumber: | 3055002137 | ||||||||
| Practice Location | |||||||||
| Address1: | 8750 SW 144TH ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | PALMETTO BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331767296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054854043 | ||||||||
| FaxNumber: | 3054853591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2007 | ||||||||
| LastUpdateDate: | 11/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | LOPETEGUI | ||||||||
| AuthorizedOfficialFirstName: | JUAN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 3054857979 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | ME 87214 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 267299500 | 05 | FL | MEDICAID |