Healthcare Provider Details

I. General information

NPI: 1275529067
Provider Name (Legal Business Name): TONY BIEN-AIME M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 05/03/2006

III. Provider practice location address

19503 NW 57TH AVE SUITE A
MIAMI FL
33055-4709
US

IV. Provider business mailing address

19503 NW 57TH AVE SUITE A
MIAMI FL
33055-4709
US

V. Phone/Fax

Practice location:
  • Phone: 305-621-8080
  • Fax: 305-624-2671
Mailing address:
  • Phone: 305-621-8080
  • Fax: 305-624-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME0056597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: