MEDICARE: MULTISPECIALTY MEDICAL CENTER 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	174400000X	Specialist

General Provider Information

NPI Number	:	1306046057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULTISPECIALTY MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	16372 NE 26TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16372 NE 26TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4004
Country	:	US
Telephone Number	:	305-945-8131
Fax Number	:

Authorized Official
Title or Position	:	MBR
Name	:	ELAINE KROYTOR
Credential	:
Telephone Number	:	305-945-8131

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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Directions to “MULTISPECIALTY MEDICAL CENTER LLC ” Practice Location

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