Healthcare Provider Details

I. General information

NPI: 1861183287
Provider Name (Legal Business Name): LIFE HEART MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 W 29TH ST
HIALEAH FL
33012-5610
US

IV. Provider business mailing address

923 W 29TH ST
HIALEAH FL
33012-5610
US

V. Phone/Fax

Practice location:
  • Phone: 786-616-8932
  • Fax:
Mailing address:
  • Phone: 786-332-9466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC MILLER
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 786-616-8932