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NPI Code Detail

MEDICARE: FLORIDA COMPASSIONATE LLC

MEDICARE: FLORIDA COMPASSIONATE 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1447951397
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLORIDA COMPASSIONATE LLC
Provider Business Mailing Address
First Line : 1161 NE 202ND ST
Second Line :
City : MIAMI
State : FL
Zip : 33179-2621
Country : US
Telephone Number : 786-532-6103
Fax Number :
Provider Business Practice Location Address
First Line : 1161 NE 202ND ST
Second Line :
City : MIAMI
State : FL
Zip : 33179-2621
Country : US
Telephone Number : 786-532-6103
Fax Number :
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : AL BERRY
Credential :
Telephone Number : 800-000-0000
Provider Enumeration Date : 03/16/2023
Last Update Date : 02/12/2026

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Directions to “FLORIDA COMPASSIONATE LLC ” Practice Location

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