Provider Demographics
NPI:1164474052
Name:LOYALTY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:LOYALTY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-599-1990
Mailing Address - Street 1:1150 NW 72ND AVE
Mailing Address - Street 2:SUITE 720
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1936
Mailing Address - Country:US
Mailing Address - Phone:305-599-1990
Mailing Address - Fax:305-599-1544
Practice Address - Street 1:1150 NW 72ND AVE
Practice Address - Street 2:SUITE 720
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1936
Practice Address - Country:US
Practice Address - Phone:305-599-1990
Practice Address - Fax:305-599-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4413207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4536Medicare ID - Type UnspecifiedGROUP PROVIDE NUMBER