Provider Demographics
NPI:1922150085
Name:AHKA MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:AHKA MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OTHON
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-225-2466
Mailing Address - Street 1:8370 W FLAGLER ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2094
Mailing Address - Country:US
Mailing Address - Phone:305-225-2466
Mailing Address - Fax:305-225-2467
Practice Address - Street 1:8370 W FLAGLER ST
Practice Address - Street 2:SUITE 222
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2094
Practice Address - Country:US
Practice Address - Phone:305-225-2466
Practice Address - Fax:305-225-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18675174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94068Medicare ID - Type Unspecified