Healthcare Provider Details

I. General information

NPI: 1710238381
Provider Name (Legal Business Name): SEASONS MEDICAL GROUP OF FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 NE 2ND AVE FL 3
MIAMI FL
33137-2706
US

IV. Provider business mailing address

6400 SHAFER CT STE 300A
ROSEMONT IL
60018-4914
US

V. Phone/Fax

Practice location:
  • Phone: 877-731-9299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARRIE BILL
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 847-692-1148