Provider Demographics
NPI:1568497352
Name:YOLAINE MARIE CHAMBLIN MD PA
Entity Type:Organization
Organization Name:YOLAINE MARIE CHAMBLIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLAINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CHAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-200-1552
Mailing Address - Street 1:6785 BROOKLINE DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2441
Mailing Address - Country:US
Mailing Address - Phone:305-200-1552
Mailing Address - Fax:305-200-1552
Practice Address - Street 1:8910 MIRAMAR PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-4100
Practice Address - Country:US
Practice Address - Phone:954-442-6988
Practice Address - Fax:954-442-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 88893261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH59677Medicare UPIN