Provider Demographics
NPI:1881643864
Name:ADCOS 75 MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ADCOS 75 MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-597-0869
Mailing Address - Street 1:1150 NW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1936
Mailing Address - Country:US
Mailing Address - Phone:305-597-0869
Mailing Address - Fax:305-597-0873
Practice Address - Street 1:1150 NW 72ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1936
Practice Address - Country:US
Practice Address - Phone:305-597-0869
Practice Address - Fax:305-597-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7818Medicare ID - Type UnspecifiedGROUP PROVIDER
FLD55989Medicare UPIN
FL51161Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER