Provider Demographics
NPI:1588831499
Name:UNIVERSITY OF MIAMI - EARLY STEPS PROGRAM
Entity Type:Organization
Organization Name:UNIVERSITY OF MIAMI - EARLY STEPS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-243-6660
Mailing Address - Street 1:1120 NW 14TH ST # C208
Mailing Address - Street 2:12TH FLOOR - ROOM 1210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2107
Mailing Address - Country:US
Mailing Address - Phone:305-243-6660
Mailing Address - Fax:305-243-3501
Practice Address - Street 1:1120 NW 14TH ST # C208
Practice Address - Street 2:12TH FLOOR - ROOM 1210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2107
Practice Address - Country:US
Practice Address - Phone:305-243-6660
Practice Address - Fax:305-243-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891731100Medicaid