Provider Demographics
NPI:1386833143
Name:HEALTHFIRST MEDICAL PA
Entity Type:Organization
Organization Name:HEALTHFIRST MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KANSKY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELISMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-325-0809
Mailing Address - Street 1:PO BOX 566264
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-6264
Mailing Address - Country:US
Mailing Address - Phone:305-325-0809
Mailing Address - Fax:305-456-3509
Practice Address - Street 1:4770 BISCAYNE BLVD
Practice Address - Street 2:STE 150
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3202
Practice Address - Country:US
Practice Address - Phone:305-325-0809
Practice Address - Fax:305-456-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI24577Medicare UPIN