Provider Demographics
NPI:1477634129
Name:MEDINA, CLIFFORD E (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:E
Last Name:MEDINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4300 ALTON RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2948
Mailing Address - Country:US
Mailing Address - Phone:305-674-5159
Mailing Address - Fax:305-535-7999
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:SUITE 440
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2948
Practice Address - Country:US
Practice Address - Phone:305-674-5159
Practice Address - Fax:305-535-7999
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC22239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H22038Medicare UPIN