Healthcare Provider Details

I. General information

NPI: 1356630628
Provider Name (Legal Business Name): PHYSICIAN PRACTICES OF MSMC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD SUITE 830
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

P.O. BOX 403429
MIAMI BEACH FL
33140-1429
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2404
  • Fax: 305-674-2544
Mailing address:
  • Phone: 305-674-2841
  • Fax: 303-535-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME388396
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME36383
License Number StateFL

VIII. Authorized Official

Name: MR. WAYNE CHUTKAN
Title or Position: VP OF FINACE
Credential:
Phone: 305-674-2662