Provider Demographics
NPI:1073692505
Name:COURTESY MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:COURTESY MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAYRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-262-8252
Mailing Address - Street 1:8080 W FLAGLER ST
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2100
Mailing Address - Country:US
Mailing Address - Phone:305-262-8252
Mailing Address - Fax:305-262-4122
Practice Address - Street 1:8080 W FLAGLER ST
Practice Address - Street 2:SUITE 3D
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2100
Practice Address - Country:US
Practice Address - Phone:305-262-8252
Practice Address - Fax:305-262-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
FL363AM0700X363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID
FLK6027Medicare ID - Type Unspecified
FL=========OtherTAX ID
FLK6027Medicare PIN