MEDICARE: MI AMIGO PEDIATRA, PA

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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1356523245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MI AMIGO PEDIATRA, PA

Provider Business Mailing Address
First Line	:	240 HIALEAH DR
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-5219
Country	:	US
Telephone Number	:	305-888-3338
Fax Number	:	305-888-3359

Provider Business Practice Location Address
First Line	:	240 HIALEAH DR
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-5219
Country	:	US
Telephone Number	:	305-888-3338
Fax Number	:	305-888-3359

Authorized Official
Title or Position	:	DOCTOR
Name	:	MIRIAM ESTEVEZ
Credential	:	MD
Telephone Number	:	305-888-3338

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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