Provider Demographics
NPI:1922030543
Name:MENENDEZ, AMOS R (MD)
Entity Type:Individual
Prefix:
First Name:AMOS
Middle Name:R
Last Name:MENENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 NW 23RD AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3395
Mailing Address - Country:US
Mailing Address - Phone:305-541-3881
Mailing Address - Fax:305-642-9534
Practice Address - Street 1:711 NW 23RD AVE STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3395
Practice Address - Country:US
Practice Address - Phone:305-541-3881
Practice Address - Fax:305-642-9534
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033341208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068504600Medicaid
FL068504600Medicaid
FL95038AMedicare PIN