MEDICARE: PAULE BAZILE, 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	261QM2500X	Medical Specialty Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1518296573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAULE BAZILE, LLC

Provider Business Mailing Address
First Line	:	6464 N. MIAMI AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33150-4520
Country	:	US
Telephone Number	:	305-756-8890
Fax Number	:	305-758-5769

Provider Business Practice Location Address
First Line	:	6464 N. MIAMI AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33150-4520
Country	:	US
Telephone Number	:	305-756-8890
Fax Number	:	305-758-5769

Authorized Official
Title or Position	:	DO/DIRECTOR
Name	:	CHARLES H RICHARD
Credential	:	DO
Telephone Number	:	305-756-8890

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	03/09/2020

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Directions to “PAULE BAZILE, LLC ” Practice Location

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