Provider Demographics
NPI:1003063009
Name:MOMCILOV, SUHAILL
Entity Type:Individual
Prefix:
First Name:SUHAILL
Middle Name:
Last Name:MOMCILOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 S RED RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3622
Mailing Address - Country:US
Mailing Address - Phone:305-667-4515
Mailing Address - Fax:786-533-1502
Practice Address - Street 1:8940 N KENDALL DR
Practice Address - Street 2:SUITE # 504E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2148
Practice Address - Country:US
Practice Address - Phone:305-595-6200
Practice Address - Fax:786-533-1502
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist