Healthcare Provider Details

I. General information

NPI: 1710764154
Provider Name (Legal Business Name): PREMIUM HEALTHCARE PLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 SW 24TH ST
MIAMI FL
33165-7598
US

IV. Provider business mailing address

9750 SW 24TH ST
MIAMI FL
33165-7598
US

V. Phone/Fax

Practice location:
  • Phone: 305-265-4441
  • Fax: 305-265-4844
Mailing address:
  • Phone: 305-746-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KEILA HOOVER
Title or Position: OWNER
Credential: MD
Phone: 305-458-0211