Provider Demographics
NPI:1932657921
Name:OAKS MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:OAKS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUCURULLO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-822-1243
Mailing Address - Street 1:7761 NW 146TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1559
Mailing Address - Country:US
Mailing Address - Phone:305-822-1243
Mailing Address - Fax:305-822-4260
Practice Address - Street 1:7761 NW 146TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1559
Practice Address - Country:US
Practice Address - Phone:305-822-1243
Practice Address - Fax:305-822-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84810207R00000X
FLPA 9100128363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty