| South Miami Medical Group Llc | |
|
7400 Sw 50th Ter Ste 203 Miami FL 33155-4486 | |
| (786) 534-8131 | |
| (786) 534-8191 |
| Full Name | South Miami Medical Group Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 7400 Sw 50th Ter Ste 203, Miami, Florida |
| Authorized Official Name and Position | Edgar Gonzalez (PHYSICIAN) |
| Authorized Official Contact | 7867183739 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Miami Medical Group Llc 7400 Sw 50th Ter Ste 203 Miami FL 33155-4486 Ph: (786) 534-8131 | South Miami Medical Group Llc 7400 Sw 50th Ter Ste 203 Miami FL 33155-4486 Ph: (786) 534-8131 |
| NPI Number | 1659940179 |
|---|---|
| Provider Enumeration Date | 06/19/2021 |
| Last Update Date | 07/16/2021 |
| Medicare PECOS PAC ID | 3678971116 |
|---|---|
| Medicare Enrollment ID | O20211013002079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659940179 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Edgar Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801132121 PECOS PAC ID: 9830484237 Enrollment ID: I20160824002080 |
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