Healthcare Provider Details

I. General information

NPI: 1518402627
Provider Name (Legal Business Name): URHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5931 NW 173RD DR SUITE #1
HIALEAH FL
33015-5106
US

IV. Provider business mailing address

5931 NW 173RD DR SUITE #1
HIALEAH FL
33015-5106
US

V. Phone/Fax

Practice location:
  • Phone: 305-454-8798
  • Fax:
Mailing address:
  • Phone: 305-454-8798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANITA PETTEWAY
Title or Position: PHYSICIAN
Credential: MD
Phone: 305-454-8798