Healthcare Provider Details

I. General information

NPI: 1497670517
Provider Name (Legal Business Name): METABOLIC HEALTH GROUP OF FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 PONCE DE LEON BLVD
CORAL GABLES FL
33134-5039
US

IV. Provider business mailing address

390 NE 191ST ST STE 54562
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 240-475-7200
  • Fax:
Mailing address:
  • Phone: 240-475-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL GORDON
Title or Position: PRESIDENT
Credential: MD
Phone: 443-929-6221