MEDICARE: ALFREDO HEVIA MD PA

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	208D00000X	General Practice Physician	ME89871	FL

General Provider Information

NPI Number	:	1861849861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALFREDO HEVIA MD PA

Provider Business Mailing Address
First Line	:	10390 SW 97TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-2715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10390 SW 97TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-2715
Country	:	US
Telephone Number	:	718-200-4016
Fax Number	:

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	JUAN LOPEZ
Credential	:
Telephone Number	:	305-251-3991

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	05/19/2016

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