Provider Demographics
NPI:1407687031
Name:MAX MED GROUP CORP
Entity type:Organization
Organization Name:MAX MED GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:RAFAELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-603-7613
Mailing Address - Street 1:174 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4608
Mailing Address - Country:US
Mailing Address - Phone:786-603-7613
Mailing Address - Fax:
Practice Address - Street 1:174 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4608
Practice Address - Country:US
Practice Address - Phone:786-603-7613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty