Healthcare Provider Details

I. General information

NPI: 1093195240
Provider Name (Legal Business Name): SOL MD HEALTHCARE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17940 NW 27TH AVE
MIAMI GARDENS FL
33056-3505
US

IV. Provider business mailing address

2436 N FEDERAL HWY STE 229
LIGHTHOUSE POINT FL
33064-6854
US

V. Phone/Fax

Practice location:
  • Phone: 305-621-8899
  • Fax:
Mailing address:
  • Phone: 561-543-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME89553
License Number StateFL

VIII. Authorized Official

Name: XUNDA A. GIBSON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-621-8899