Provider Demographics
NPI:1306859012
Name:INTERNAL MEDICINE OF MIAMI GARDENS INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF MIAMI GARDENS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-628-4600
Mailing Address - Street 1:18300 NW 62ND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8200
Mailing Address - Country:US
Mailing Address - Phone:305-628-4600
Mailing Address - Fax:305-628-8090
Practice Address - Street 1:18300 NW 62ND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-8200
Practice Address - Country:US
Practice Address - Phone:305-628-4600
Practice Address - Fax:305-628-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51638207R00000X, 207RR0500X
FLME85282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265636101Medicaid
FL265636100Medicaid
K3978Medicare ID - Type UnspecifiedGROUP
FL265636101Medicaid