MEDICARE: MEDPLAN CLINICS , 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	207R00000X	Internal Medicine Physician
2	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689035917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDPLAN CLINICS , LLC

Provider Business Mailing Address
First Line	:	8750 NW 36TH STREET
Second Line	:	SUITE 300
City	:	DORAL
State	:	FL
Zip	:	33178
Country	:	US
Telephone Number	:	786-641-5348
Fax Number	:	305-615-1121

Provider Business Practice Location Address
First Line	:	150 NW 168TH ST # 301
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33169-6045
Country	:	US
Telephone Number	:	305-962-1789
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MANUEL IGLESIAS
Credential	:
Telephone Number	:	786-641-5348

Provider Enumeration Date	:	03/15/2016
Last Update Date	:	06/12/2017

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