Provider Demographics
NPI:1346381555
Name:ASSOCIATION OF MINIMALLY INVASIVE GYNECOLOGIC SURGEONS
Entity Type:Organization
Organization Name:ASSOCIATION OF MINIMALLY INVASIVE GYNECOLOGIC SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PIETRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-596-3744
Mailing Address - Street 1:8740 N KENDALL DR
Mailing Address - Street 2:STE. 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2212
Mailing Address - Country:US
Mailing Address - Phone:305-596-3744
Mailing Address - Fax:305-596-3676
Practice Address - Street 1:8740 N KENDALL DR
Practice Address - Street 2:STE. 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2212
Practice Address - Country:US
Practice Address - Phone:305-596-3744
Practice Address - Fax:305-596-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59300207VG0400X
FLME77737207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23087OtherBCBS
FL47182OtherBCBS
FLF32226Medicare UPIN
FL47182Medicare ID - Type Unspecified
FLF65477Medicare UPIN
FL23087Medicare ID - Type Unspecified