Healthcare Provider Details

I. General information

NPI: 1356351605
Provider Name (Legal Business Name): BERAJA MEDICAL INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 S DOUGLAS RD
CORAL GABLES FL
33134-6126
US

IV. Provider business mailing address

44 BARKLEY CIR
FORT MYERS FL
33907-7530
US

V. Phone/Fax

Practice location:
  • Phone: 305-443-7070
  • Fax: 305-357-1701
Mailing address:
  • Phone: 239-985-7171
  • Fax: 392-985-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: THOMAS ALBERT QUIGLEY
Title or Position: DIRECTOR
Credential:
Phone: 239-466-2020