Provider Demographics
NPI:1407222102
Name:MIAMI MEDICAL WELLNESS, PLLC
Entity Type:Organization
Organization Name:MIAMI MEDICAL WELLNESS, PLLC
Other - Org Name:VIOR LIFE & AESTHETIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-448-2600
Mailing Address - Street 1:3850 BIRD RD
Mailing Address - Street 2:402B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1501
Mailing Address - Country:US
Mailing Address - Phone:305-448-2600
Mailing Address - Fax:305-390-3011
Practice Address - Street 1:3850 BIRD RD
Practice Address - Street 2:402B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-1501
Practice Address - Country:US
Practice Address - Phone:305-448-2600
Practice Address - Fax:305-390-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10986111N00000X
FLAP2395171100000X
FLOS12411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty