Healthcare Provider Details

I. General information

NPI: 1982204616
Provider Name (Legal Business Name): SOUTH FLORIDA MULTI-SPECIALTY MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BILTMORE WAY STE 205
CORAL GABLES FL
33134-5736
US

IV. Provider business mailing address

8950 SW 74TH CT STE 1408
MIAMI FL
33156-3173
US

V. Phone/Fax

Practice location:
  • Phone: 833-735-3668
  • Fax: 866-897-7014
Mailing address:
  • Phone: 833-735-3668
  • Fax: 866-897-7014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER HANY HANNA
Title or Position: OWNER/CEO
Credential: DPM
Phone: 973-900-1198