Provider Demographics
NPI:1578216875
Name:NUE LIFE MEDICAL GROUP (DE), P.A.
Entity Type:Organization
Organization Name:NUE LIFE MEDICAL GROUP (DE), P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-985-6170
Mailing Address - Street 1:309 23RD ST STE 230
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1700
Mailing Address - Country:US
Mailing Address - Phone:305-985-6170
Mailing Address - Fax:305-985-6170
Practice Address - Street 1:309 23RD ST STE 230
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1700
Practice Address - Country:US
Practice Address - Phone:305-985-6170
Practice Address - Fax:305-985-6170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty