Provider Demographics
NPI:1225074230
Name:MIAMI MEDICAL GROUP INC
Entity Type:Organization
Organization Name:MIAMI MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-445-0048
Mailing Address - Street 1:4505 W FLAGLER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1500
Mailing Address - Country:US
Mailing Address - Phone:305-445-0048
Mailing Address - Fax:305-569-0071
Practice Address - Street 1:4505 W FLAGLER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1500
Practice Address - Country:US
Practice Address - Phone:305-445-0048
Practice Address - Fax:305-569-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM13278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98236Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER