Provider Demographics
NPI:1013175074
Name:SOUTH FLORIDA INTERNISTS GROUP PA
Entity Type:Organization
Organization Name:SOUTH FLORIDA INTERNISTS GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDEBOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-623-6490
Mailing Address - Street 1:1312 SW 27TH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1243
Mailing Address - Country:US
Mailing Address - Phone:786-409-2407
Mailing Address - Fax:778-095-9368
Practice Address - Street 1:1312 SW 27TH AVENUE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1243
Practice Address - Country:US
Practice Address - Phone:786-409-2407
Practice Address - Fax:877-809-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QA0505X
FLOS8492207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1073567640Medicaid
FL1720076144Medicaid
FL1508167628Medicaid
FL1063062842Medicaid
FL1285854125Medicaid