MEDICARE: MARCUS DISTRIBUTORS CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1013422153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCUS DISTRIBUTORS CORP

Provider Business Mailing Address
First Line	:	15160 SW 136TH ST UNIT 10
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-2664
Country	:	US
Telephone Number	:	786-718-4816
Fax Number	:

Provider Business Practice Location Address
First Line	:	15160 SW 136TH ST UNIT 10
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-2664
Country	:	US
Telephone Number	:	786-718-4816
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VLADIMIR CASAS
Credential	:
Telephone Number	:	786-718-4816

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/12/2017

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Directions to “MARCUS DISTRIBUTORS CORP ” Practice Location

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