Provider Demographics
NPI:1568726636
Name:CPC MEDICAL CENTER@MILLER DRIVE
Entity Type:Organization
Organization Name:CPC MEDICAL CENTER@MILLER DRIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERVONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-854-6661
Mailing Address - Street 1:10240 SW 56TH ST
Mailing Address - Street 2:106
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7071
Mailing Address - Country:US
Mailing Address - Phone:305-598-8805
Mailing Address - Fax:
Practice Address - Street 1:10240 SW 56TH ST
Practice Address - Street 2:106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7071
Practice Address - Country:US
Practice Address - Phone:305-598-8805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty