MEDICARE: FAMILY PHYSICIANS ASSOCIATES INC

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	ME104648	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104648	OTHER	FL	ME LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902125545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHYSICIANS ASSOCIATES INC

Provider Business Mailing Address
First Line	:	4308 ALTON RD
Second Line	:	SUITE 420
City	:	MIAMI
State	:	FL
Zip	:	33140
Country	:	US
Telephone Number	:	786-464-9261
Fax Number	:	305-503-6903

Provider Business Practice Location Address
First Line	:	5757 COLLINS AVE
Second Line	:	APT 1002
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2300
Country	:	US
Telephone Number	:	305-903-7646
Fax Number	:	305-503-6903

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS LIVIA CORAL GADEA
Credential	:	MD
Telephone Number	:	786-464-9261

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	10/15/2011

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