Healthcare Provider Details

I. General information

NPI: 1811873672
Provider Name (Legal Business Name): TELECHECK HEALTH MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 NE 191ST ST # 69811
MIAMI FL
33179-3899
US

IV. Provider business mailing address

382 NE 191ST ST # 69811
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 702-763-4376
  • Fax:
Mailing address:
  • Phone: 702-763-4376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MITCHELL STOTLAND
Title or Position: PRESIDENT
Credential: MD
Phone: 702-763-4376