Healthcare Provider Details

I. General information

NPI: 1528090305
Provider Name (Legal Business Name): TAMAYO CHELALA AND MILLER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD SUITE 490
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

4302 ALTON RD SUITE 490
MIAMI BEACH FL
33140-2891
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-6797
  • Fax: 305-674-0784
Mailing address:
  • Phone: 305-674-6797
  • Fax: 305-674-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANDRE TAMAYO CHELALA
Title or Position: PHYSICIAN
Credential: DO
Phone: 305-674-6797