MEDICARE: MUKAMAS 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	207Q00000X	Family Medicine Physician

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	:	1770210346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUKAMAS LLC

Provider Business Mailing Address
First Line	:	410 W 41ST ST # 103
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3504
Country	:	US
Telephone Number	:	305-720-2288
Fax Number	:	217-771-1814

Provider Business Practice Location Address
First Line	:	410 W 41ST ST # 103
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3504
Country	:	US
Telephone Number	:	305-720-2288
Fax Number	:	217-771-1814

Authorized Official
Title or Position	:	CEO
Name	:	RACHAEL NAMBUSI
Credential	:	MD
Telephone Number	:	305-744-4922

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	04/24/2024

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Directions to “MUKAMAS LLC ” Practice Location

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