Healthcare Provider Details

I. General information

NPI: 1336199710
Provider Name (Legal Business Name): DOMINIC C MAGGIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NW 14TH ST SUITE 200
MIAMI FL
33125-1673
US

IV. Provider business mailing address

1321 NW 14TH ST SUITE 200
MIAMI FL
33125-1673
US

V. Phone/Fax

Practice location:
  • Phone: 305-324-0220
  • Fax: 305-545-0790
Mailing address:
  • Phone: 305-324-0220
  • Fax: 305-545-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME0032856
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME32856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: