Provider Demographics
NPI:1356883557
Name:MI CASA MEDICAL CENTERS LLC
Entity type:Organization
Organization Name:MI CASA MEDICAL CENTERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-390-2729
Mailing Address - Street 1:8356 SW 40TH ST STE ABC
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3356
Mailing Address - Country:US
Mailing Address - Phone:305-390-2729
Mailing Address - Fax:305-676-6628
Practice Address - Street 1:8356 SW 40TH ST STE ABC
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3356
Practice Address - Country:US
Practice Address - Phone:305-390-2729
Practice Address - Fax:305-676-6628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-06
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center