Provider Demographics
NPI:1538651880
Name:AC MEDICAL ASSOCIATES I, INC.
Entity Type:Organization
Organization Name:AC MEDICAL ASSOCIATES I, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALIUSKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMENATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-333-4410
Mailing Address - Street 1:4770 BISCAYNE BLVD STE 1450
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3237
Mailing Address - Country:US
Mailing Address - Phone:786-536-2003
Mailing Address - Fax:800-536-1148
Practice Address - Street 1:4770 BISCAYNE BLVD STE 1450
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3237
Practice Address - Country:US
Practice Address - Phone:786-536-2003
Practice Address - Fax:800-536-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-02
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116206207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME116206OtherMEDICAL LICENSE