Provider Demographics
NPI:1558425090
Name:MIAMI ASSOCIATES IN PEDIATRIC SURGERY PA
Entity Type:Organization
Organization Name:MIAMI ASSOCIATES IN PEDIATRIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURNWELT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-662-8322
Mailing Address - Street 1:3200 SW 60TH CT
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4000
Mailing Address - Country:US
Mailing Address - Phone:305-662-8320
Mailing Address - Fax:305-665-2467
Practice Address - Street 1:3200 SW 60TH CT
Practice Address - Street 2:SUITE # 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4000
Practice Address - Country:US
Practice Address - Phone:305-662-8320
Practice Address - Fax:305-665-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52854400Medicaid
FL52870600Medicaid
FL273190800Medicaid
FL30631200Medicaid
FL64668700Medicaid
FL30631200Medicaid
FL64668700Medicaid
FLD59577Medicare UPIN
FLD13975Medicare UPIN
FLD12893Medicare UPIN