Healthcare Provider Details

I. General information

NPI: 1013691070
Provider Name (Legal Business Name): MD MAX HEALTHCARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 SW 107TH AVE
MIAMI FL
33165-3632
US

IV. Provider business mailing address

3421 SW 107TH AVE
MIAMI FL
33165-3632
US

V. Phone/Fax

Practice location:
  • Phone: 305-934-1160
  • Fax:
Mailing address:
  • Phone: 305-934-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JORGE E SANDELIS PEREZ
Title or Position: P
Credential: MD
Phone: 305-934-1160