Provider Demographics
NPI:1851982169
Name:MIAMI BLU SKY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:MIAMI BLU SKY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXEIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ LACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-409-4379
Mailing Address - Street 1:85 GRAND CANAL DR STE 407
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2571
Mailing Address - Country:US
Mailing Address - Phone:786-409-4379
Mailing Address - Fax:786-409-4217
Practice Address - Street 1:85 GRAND CANAL DR STE 407
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2571
Practice Address - Country:US
Practice Address - Phone:786-409-4379
Practice Address - Fax:786-409-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty