MEDICARE: ORTHOMIAMI

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
3	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1235828914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOMIAMI

Provider Business Mailing Address
First Line	:	7800 SW 87TH AVE SUITE A110
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173
Country	:	US
Telephone Number	:	305-596-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	3905 NW 107TH AVE STE 403
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-2785
Country	:	US
Telephone Number	:	305-596-2828
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	NICOLE HOMMEN
Credential	:
Telephone Number	:	305-596-2828

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2024

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Directions to “ORTHOMIAMI ” Practice Location

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