| Miracle Medical Center | |
|
15660 Sw 72nd St Miami FL 33193-1923 | |
| (786) 697-1150 | |
| Not Available |
| Full Name | Miracle Medical Center |
|---|---|
| Speciality | General Practice |
| Location | 15660 Sw 72nd St, Miami, Florida |
| Authorized Official Name and Position | Brisaida Duarte (CEO) |
| Authorized Official Contact | 7866971150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miracle Medical Center 15660 Sw 72nd St Miami FL 33193-1923 Ph: (786) 697-1150 | Miracle Medical Center 15660 Sw 72nd St Miami FL 33193-1923 Ph: (786) 697-1150 |
| NPI Number | 1700491552 |
|---|---|
| Provider Enumeration Date | 09/09/2020 |
| Last Update Date | 08/25/2023 |
| Medicare PECOS PAC ID | 0840600359 |
|---|---|
| Medicare Enrollment ID | O20201111001510 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700491552 | NPI | - | NPPES |
| 118354400 | Medicaid | FL | |
| 42711 | Other | FL | HEALTH CARE CLINIC CERTIFICATE (AHCA) |
| 15527884 | Other | FL | CAQH |
| Provider Name | Ketty Maurice |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053368043 PECOS PAC ID: 0446143382 Enrollment ID: I20040205000130 |
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