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505 Ne 125th St North Miami FL 33161-4718 | |
| (786) 235-7240 | |
| (786) 235-7241 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 505 Ne 125th St, North Miami, Florida |
| Authorized Official Name and Position | Igor Niznik (PRESIDENT/OWNER) |
| Authorized Official Contact | 7862357240 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
505 Ne 125th St North Miami FL 33161-4718 Ph: (786) 235-7240 | 505 Ne 125th St North Miami FL 33161-4718 Ph: (786) 235-7240 |
| NPI Number | 1255633046 |
|---|---|
| Provider Enumeration Date | 11/30/2010 |
| Last Update Date | 11/30/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255633046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | PMC20 (Florida) | Primary |
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