MEDICARE: MEDCAL, INC.

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1023421195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDCAL, INC.

Provider Business Mailing Address
First Line	:	14540 SW 136TH ST
Second Line	:	SUITE 102
City	:	MIAMI
State	:	FL
Zip	:	33186-6777
Country	:	US
Telephone Number	:	786-228-9926
Fax Number	:

Provider Business Practice Location Address
First Line	:	14540 SW 136TH ST
Second Line	:	SUITE 102
City	:	MIAMI
State	:	FL
Zip	:	33186-6777
Country	:	US
Telephone Number	:	786-228-9926
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT CALHOUN
Credential	:
Telephone Number	:	786-228-9926

Provider Enumeration Date	:	06/06/2014
Last Update Date	:	06/06/2014

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