MEDICARE: PASTEUR MEDICAL HIALEAH GARDENS, 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1447691753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASTEUR MEDICAL HIALEAH GARDENS, LLC

Provider Business Mailing Address
First Line	:	3300 W 84TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 W 84TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4903
Country	:	US
Telephone Number	:	786-422-6821
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	TARIK HAWATMEH
Credential	:
Telephone Number	:	786-422-6821

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	02/21/2017

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