Provider Demographics
NPI:1174523732
Name:BAZIL-MIESES, OSVALDO DARIO (MD)
Entity type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:DARIO
Last Name:BAZIL-MIESES
Suffix:
Gender:
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:URB VISTA VERDE #6 CALLE CORAL
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-2508
Mailing Address - Country:US
Mailing Address - Phone:915-329-7814
Mailing Address - Fax:939-935-9006
Practice Address - Street 1:URB. VISTA VERDE #6 CALLE CORAL
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-2508
Practice Address - Country:US
Practice Address - Phone:915-329-7814
Practice Address - Fax:939-935-9006
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3985207R00000X
PR8215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C77684Medicare UPIN
TX8G6239Medicare PIN
TX00299LMedicare ID - Type Unspecified
TX8DH693OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX135289012Medicaid
TX135289010OtherMEDICAID HEALTH STEPS
TX135289006Medicaid
TX8G6239Medicare PIN