Healthcare Provider Details

I. General information

NPI: 1356809057
Provider Name (Legal Business Name): PRIVAMEDIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD STE 880
MIAMI BEACH FL
33140-4560
US

IV. Provider business mailing address

4308 ALTON RD STE 880
MIAMI BEACH FL
33140-4560
US

V. Phone/Fax

Practice location:
  • Phone: 305-604-2888
  • Fax: 305-604-2887
Mailing address:
  • Phone: 305-604-2888
  • Fax: 305-604-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY JOSEPH MERLINO
Title or Position: PHYSICIANS / PRESIDENT
Credential: D.O.
Phone: 304-604-2888