MEDICARE: DR. ANITA JANINE MEDINA D.O.

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	208M00000X	Hospitalist Physician	OS11420	FL
2	207R00000X	Internal Medicine Physician	OS11420	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OS11420	OTHER	FL	FLORIDA MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528208915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITA JANINE MEDINA D.O.

Provider Business Mailing Address
First Line	:	13087 SW 197TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-4807
Country	:	US
Telephone Number	:	305-773-7411
Fax Number	:

Provider Business Practice Location Address
First Line	:	13087 SW 197TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-4807
Country	:	US
Telephone Number	:	305-773-7411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	09/12/2011

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