Provider Demographics
NPI:1467663096
Name:COURTESY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:COURTESY MEDICAL GROUP, INC.
Other - Org Name:COURTESY MEDICAL GROUP, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAYRO
Authorized Official - Suffix:X
Authorized Official - Credentials:ETC
Authorized Official - Phone:305-899-0683
Mailing Address - Street 1:1175 NE 125TH ST
Mailing Address - Street 2:#409
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5015
Mailing Address - Country:US
Mailing Address - Phone:305-899-0683
Mailing Address - Fax:305-899-0685
Practice Address - Street 1:1175 NE 125TH ST
Practice Address - Street 2:#409
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5015
Practice Address - Country:US
Practice Address - Phone:305-899-0683
Practice Address - Fax:305-899-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6027Medicare ID - Type UnspecifiedMEDICARE PART B