Healthcare Provider Details

I. General information

NPI: 1922519420
Provider Name (Legal Business Name): GASTRO HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4791 W 4TH AVE
HIALEAH FL
33012-3938
US

IV. Provider business mailing address

9500 S DADELAND BLVD 200
MIAMI FL
33156-2866
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-0500
  • Fax: 305-825-5557
Mailing address:
  • Phone: 305-468-4185
  • Fax: 305-675-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: JAMES S LEAVITT
Title or Position: PRESIDENT
Credential: MD
Phone: 305-468-4180