Provider Demographics
NPI:1689701302
Name:MIAMI HIALEAH MEDICAL GROUP
Entity Type:Organization
Organization Name:MIAMI HIALEAH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-696-0842
Mailing Address - Street 1:1025 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3703
Mailing Address - Country:US
Mailing Address - Phone:305-696-0842
Mailing Address - Fax:305-696-2150
Practice Address - Street 1:1025 E 25TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3703
Practice Address - Country:US
Practice Address - Phone:305-696-0842
Practice Address - Fax:305-696-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLWAIVED2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty