MEDICARE: ADVANCE MEDICAL GROUP LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1144938549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	3400 CORAL WAY STE 603
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3070
Country	:	US
Telephone Number	:	305-772-8107
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 CORAL WAY STE 603
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3070
Country	:	US
Telephone Number	:	305-772-8107
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LEXANDER GONZALEZ
Credential	:
Telephone Number	:	305-772-8107

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	05/02/2023

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