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1801 Ne 123rd St North Miami FL 33181-2817 | |
| (305) 585-3701 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 1801 Ne 123rd St, North Miami, Florida |
| Authorized Official Name and Position | Mark T Knight (EXECUTIVE VP, CFO) |
| Authorized Official Contact | 3055858490 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 12493 Miami FL 33101-2493 Ph: (305) 585-5315 | 1801 Ne 123rd St North Miami FL 33181-2817 Ph: (305) 585-3701 |
| NPI Number | 1164115374 |
|---|---|
| Provider Enumeration Date | 06/01/2023 |
| Last Update Date | 06/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164115374 | NPI | - | NPPES |
| 0009572223 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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