Healthcare Provider Details

I. General information

NPI: 1821289604
Provider Name (Legal Business Name): SMITH MATZA & KUTNER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10095 N KENDALL DR SUITE 102
MIAMI FL
33176-1797
US

IV. Provider business mailing address

10095 N KENDALL DR SUITE 102
MIAMI FL
33176-1797
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-5455
  • Fax: 305-595-5227
Mailing address:
  • Phone: 305-595-5455
  • Fax: 305-595-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRIAM DOMINGUEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-595-5455