Healthcare Provider Details

I. General information

NPI: 1265689459
Provider Name (Legal Business Name): MIAMI GYNECOLOGIC ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE SUITE 702
HIALEAH FL
33016-1897
US

IV. Provider business mailing address

1030 REDBIRD AVE
MIAMI SPRINGS FL
33166-3223
US

V. Phone/Fax

Practice location:
  • Phone: 305-828-8688
  • Fax: 305-828-8655
Mailing address:
  • Phone: 305-828-8688
  • Fax: 305-828-8655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME77021
License Number StateFL

VIII. Authorized Official

Name: DR. EMERY MANUEL SALOM
Title or Position: OWNER
Credential: MD
Phone: 305-828-8688