Healthcare Provider Details

I. General information

NPI: 1134384423
Provider Name (Legal Business Name): PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

PO BOX 12493
MIAMI FL
33101-2493
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5315
  • Fax: 305-585-5316
Mailing address:
  • Phone: 305-585-5315
  • Fax: 305-585-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK T KNIGHT
Title or Position: EXECUTIVE VP,CFO
Credential:
Phone: 305-585-8490