Healthcare Provider Details

I. General information

NPI: 1558778399
Provider Name (Legal Business Name): MIAMI MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S MIAMI AVE STE 101
MIAMI FL
33130-4100
US

IV. Provider business mailing address

1250 S MIAMI AVE STE 101
MIAMI FL
33130-4100
US

V. Phone/Fax

Practice location:
  • Phone: 305-571-6250
  • Fax: 305-571-6251
Mailing address:
  • Phone: 305-571-6250
  • Fax: 305-571-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME117256
License Number StateFL

VIII. Authorized Official

Name: HOSSEIN JOUKAR
Title or Position: CEO
Credential: M.D.
Phone: 305-571-6250