Provider Demographics
NPI:1356439608
Name:MEDICAL PROFESSIONALS OF MIAMI, INC.
Entity Type:Organization
Organization Name:MEDICAL PROFESSIONALS OF MIAMI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-863-8860
Mailing Address - Street 1:760 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2075
Mailing Address - Country:US
Mailing Address - Phone:305-444-6167
Mailing Address - Fax:305-444-4841
Practice Address - Street 1:760 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2075
Practice Address - Country:US
Practice Address - Phone:305-444-6167
Practice Address - Fax:305-444-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77597CMedicare ID - Type UnspecifiedMEDICARE PROVIDER