Provider Demographics
NPI:1114988151
Name:PATAKY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PATAKY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:ZILIA
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:305-553-2220
Mailing Address - Street 1:12781 SW 42ND ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3437
Mailing Address - Country:US
Mailing Address - Phone:305-553-2220
Mailing Address - Fax:305-553-9753
Practice Address - Street 1:12781 SW 42ND ST
Practice Address - Street 2:SUITE G
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3437
Practice Address - Country:US
Practice Address - Phone:305-553-2220
Practice Address - Fax:305-553-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10449207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8416AOtherPTAN
H96130Medicare UPIN