| Miracle Medical Center Corp | |
|
15668 Sw 72nd St Miami FL 33193-1923 | |
| (786) 697-1150 | |
| Not Available |
| Full Name | Miracle Medical Center Corp |
|---|---|
| Speciality | Family Medicine |
| Location | 15668 Sw 72nd St, Miami, Florida |
| Authorized Official Name and Position | Brisaida Duarte (CEO) |
| Authorized Official Contact | 7863156818 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miracle Medical Center Corp 15668 Sw 72nd St Miami FL 33193-1923 Ph: (786) 697-1150 | Miracle Medical Center Corp 15668 Sw 72nd St Miami FL 33193-1923 Ph: (786) 697-1150 |
| NPI Number | 1144966680 |
|---|---|
| Provider Enumeration Date | 05/09/2022 |
| Last Update Date | 05/09/2022 |
| Medicare PECOS PAC ID | 3274989645 |
|---|---|
| Medicare Enrollment ID | O20231023000978 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144966680 | NPI | - | NPPES |
| 13077 | Other | FL | AHCA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ketty Maurice |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053368043 PECOS PAC ID: 0446143382 Enrollment ID: I20040205000130 |
| Provider Name | Amilcar Miguel Lominchar |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1881085827 PECOS PAC ID: 2365744307 Enrollment ID: I20170221000147 |
| Provider Name | William A Dieppa |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1386245819 PECOS PAC ID: 3173937968 Enrollment ID: I20210208001721 |
| Provider Name | Manuel De La Portilla |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831357474 PECOS PAC ID: 9638521040 Enrollment ID: I20240122003678 |
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