Provider Demographics
NPI:1609832559
Name:SOUTH FLORIDA INFECTIOUS DISEASE AND TROPICAL MEDICINE CENTER LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA INFECTIOUS DISEASE AND TROPICAL MEDICINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:056-666-4044
Mailing Address - Street 1:5975 SUNSET DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5198
Mailing Address - Country:US
Mailing Address - Phone:305-666-4044
Mailing Address - Fax:305-666-8387
Practice Address - Street 1:5975 SUNSET DR STE 103
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5198
Practice Address - Country:US
Practice Address - Phone:305-666-4044
Practice Address - Fax:305-667-8387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059704207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280508100Medicaid
FL280508100Medicaid