| Anselmo Manuel Mendive, Md. Pa. | |
|
4601 Nw 199th St Suite E Miami Gardens FL 33055-1508 | |
| (305) 801-7030 | |
| (305) 623-7044 |
| Full Name | Anselmo Manuel Mendive, Md. Pa. |
|---|---|
| Speciality | Family Medicine |
| Location | 4601 Nw 199th St, Miami Gardens, Florida |
| Authorized Official Name and Position | Yin Garcia (OFFICE MANAGER) |
| Authorized Official Contact | 3058017030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Anselmo Manuel Mendive, Md. Pa. 4601 Nw 199th St Suite E Miami Gardens FL 33055-1508 Ph: (305) 801-7030 | Anselmo Manuel Mendive, Md. Pa. 4601 Nw 199th St Suite E Miami Gardens FL 33055-1508 Ph: (305) 801-7030 |
| NPI Number | 1619011228 |
|---|---|
| Provider Enumeration Date | 02/16/2007 |
| Last Update Date | 01/31/2012 |
| Medicare PECOS PAC ID | 9335306323 |
|---|---|
| Medicare Enrollment ID | O20120202000377 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619011228 | NPI | - | NPPES |
| 048992100 | Medicaid | FL | |
| 048992101 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME56412 (Florida) | Primary |
| Provider Name | Anselmo M Mendive |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427229384 PECOS PAC ID: 6507023595 Enrollment ID: I20120202000406 |
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