1679758817 NPI number — MIAMI LAKES MEDICAL CENTER ASSOCIATES, P.A.

Table of content: (NPI 1679758817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679758817 NPI number — MIAMI LAKES MEDICAL CENTER ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIAMI LAKES MEDICAL CENTER ASSOCIATES, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679758817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7150 W 20TH AVE
Provider Second Line Business Mailing Address:
SUITE 315
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33016-5529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-821-6600
Provider Business Mailing Address Fax Number:
305-821-0773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7150 W 20TH AVE
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33016-5529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-821-6600
Provider Business Practice Location Address Fax Number:
305-821-0773
Provider Enumeration Date:
01/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ZALIS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-821-6600

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME31692 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000901 . This is a "NHP KOBY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 039823300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 170130 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 02704 . This is a "MCR KOBY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4337911 . This is a "AETNA KOBY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 001729 . This is a "NHP ZALIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4521008 . This is a "AETNA ZALIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6972300 . This is a "JMH ZALIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7900000 . This is a "JMH KOBY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 79162 . This is a "MCR ZALIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 014686 . This is a "AVMED KOBY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 02704 . This is a "BCBS KOBY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 044892300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 265997 . This is a "AVMED ZALIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 79162 . This is a "BCBS ZALIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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