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6601 Sw 62nd Ave South Miami FL 33143-3300 | |
| (786) 466-6900 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 6601 Sw 62nd Ave, South Miami, Florida |
| Authorized Official Name and Position | Mark T Knight (EXECUTIVE VP, CFO) |
| Authorized Official Contact | 3055857979 |
| 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 | 6601 Sw 62nd Ave South Miami FL 33143-3300 Ph: (786) 466-6900 |
| NPI Number | 1558038091 |
|---|---|
| Provider Enumeration Date | 08/24/2021 |
| Last Update Date | 02/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558038091 | NPI | - | NPPES |
| 000957210 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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