Provider Demographics
NPI:1164420659
Name:MIAMI MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:MIAMI MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CINTRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-485-8666
Mailing Address - Street 1:12365 SW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4211
Mailing Address - Country:US
Mailing Address - Phone:305-485-8666
Mailing Address - Fax:305-485-0575
Practice Address - Street 1:13055 SW 42ND ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3406
Practice Address - Country:US
Practice Address - Phone:305-485-8666
Practice Address - Fax:305-485-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83807174400000X
FLME83858174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265261700Medicaid
FL=========OtherTIN
FL34325Medicare PIN