Provider Demographics
NPI:1225794852
Name:CONSTELLATION MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:CONSTELLATION MEDICAL GROUP LLC
Other - Org Name:ONE HEALTH MEDICAL CENTER-NORTH MIAMI BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-552-7800
Mailing Address - Street 1:1205 SW 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4226
Mailing Address - Country:US
Mailing Address - Phone:786-552-7800
Mailing Address - Fax:
Practice Address - Street 1:1850 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4867
Practice Address - Country:US
Practice Address - Phone:786-552-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSTELLATION MEDICAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty