Provider Demographics
NPI:1942297205
Name:SECADA, OTTO L (MD)
Entity type:Individual
Prefix:DR
First Name:OTTO
Middle Name:L
Last Name:SECADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7150 W 20TH AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5531
Mailing Address - Country:US
Mailing Address - Phone:305-828-5677
Mailing Address - Fax:305-828-9196
Practice Address - Street 1:7150 W 20TH AVE STE 209
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5531
Practice Address - Country:US
Practice Address - Phone:305-828-5677
Practice Address - Fax:305-828-9196
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0060146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057633600Medicaid
FL057633600Medicaid
FLE96744Medicare UPIN