Healthcare Provider Details

I. General information

NPI: 1689701302
Provider Name (Legal Business Name): MIAMI HIALEAH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 E 25TH ST
HIALEAH FL
33013-3703
US

IV. Provider business mailing address

1025 E 25TH ST
HIALEAH FL
33013-3703
US

V. Phone/Fax

Practice location:
  • Phone: 305-696-0842
  • Fax: 305-696-2150
Mailing address:
  • Phone: 305-696-0842
  • Fax: 305-696-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberWAIVED
License Number StateFL

VIII. Authorized Official

Name: DR. MONICA GRINBERG
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-696-0842