Healthcare Provider Details

I. General information

NPI: 1487611844
Provider Name (Legal Business Name): NEW LIFE MEDICAL INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 SW 8TH ST
MIAMI FL
33130-3703
US

IV. Provider business mailing address

861 SW 8TH ST
MIAMI FL
33130-3703
US

V. Phone/Fax

Practice location:
  • Phone: 305-857-9800
  • Fax: 305-857-9802
Mailing address:
  • Phone: 305-857-9800
  • Fax: 305-857-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME51394
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME28831
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE MICHAILOS
Title or Position: PRESIDENT
Credential:
Phone: 305-857-9800