Provider Demographics
NPI:1265689459
Name:MIAMI GYNECOLOGIC ONCOLOGY
Entity Type:Organization
Organization Name:MIAMI GYNECOLOGIC ONCOLOGY
Other - Org Name:MGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMERY
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:SALOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-828-8688
Mailing Address - Street 1:1030 REDBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3223
Mailing Address - Country:US
Mailing Address - Phone:305-828-8688
Mailing Address - Fax:305-828-8655
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:SUITE 702
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:305-828-8688
Practice Address - Fax:305-828-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77021207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2707900 00Medicaid
FL2707900 00Medicaid