Healthcare Provider Details

I. General information

NPI: 1285362731
Provider Name (Legal Business Name): PRIVATE MEDICAL FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LINCOLN RD STE 301&375
MIAMI BEACH FL
33139-2452
US

IV. Provider business mailing address

3580 CALIFORNIA ST STE 101
SAN FRANCISCO CA
94118-1716
US

V. Phone/Fax

Practice location:
  • Phone: 305-703-7633
  • Fax:
Mailing address:
  • Phone: 415-830-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN SHLAIN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 305-703-7633