Provider Demographics
NPI:1629172796
Name:SOUTH MIAMI MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SOUTH MIAMI MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDANT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUESADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-238-1529
Mailing Address - Street 1:9742 SW 174 STREET
Mailing Address - Street 2:UNIT 3
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157
Mailing Address - Country:US
Mailing Address - Phone:305-238-1529
Mailing Address - Fax:305-238-3467
Practice Address - Street 1:9742 SW 174 STREET
Practice Address - Street 2:UNIT 3
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:305-238-1529
Practice Address - Fax:305-238-3467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies