Provider Demographics
NPI:1780776401
Name:MED ONE MEDICAL MANAGEMENT INC
Entity type:Organization
Organization Name:MED ONE MEDICAL MANAGEMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLEMUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-688-5456
Mailing Address - Street 1:486 FISHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-3818
Mailing Address - Country:US
Mailing Address - Phone:305-688-5456
Mailing Address - Fax:305-688-1661
Practice Address - Street 1:486 FISHERMAN ST
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3818
Practice Address - Country:US
Practice Address - Phone:305-688-5456
Practice Address - Fax:305-688-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3262208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME34811OtherCARMEN URIBE LICENSE
ME67381OtherLAILA CHAGANI LICENSE
ME45180OtherPIERRE BLEMUR LICENSE
B89369Medicare UPIN
27622AMedicare ID - Type UnspecifiedLAILA CHAGANI
95474Medicare ID - Type UnspecifiedCARMEN URIBE
ME34811OtherCARMEN URIBE LICENSE
F90610Medicare UPIN
ME45180OtherPIERRE BLEMUR LICENSE
02344Medicare ID - Type UnspecifiedPIERRE BLEMUR