Provider Demographics
NPI:1821293127
Name:NORTH MIAMI MEDICAL INC
Entity Type:Organization
Organization Name:NORTH MIAMI MEDICAL INC
Other - Org Name:NORTH MIAMI MEDICAL AND REHAB INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:METELLUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-895-7840
Mailing Address - Street 1:823 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5711
Mailing Address - Country:US
Mailing Address - Phone:305-895-7840
Mailing Address - Fax:305-895-9557
Practice Address - Street 1:823 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5711
Practice Address - Country:US
Practice Address - Phone:305-895-7840
Practice Address - Fax:305-895-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5704AMedicare PIN