Healthcare Provider Details

I. General information

NPI: 1295406726
Provider Name (Legal Business Name): SOUTH MIAMI GYN ONCOLOGY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15955 SW 96TH ST STE 400
MIAMI FL
33196-1273
US

IV. Provider business mailing address

PO BOX 742057
ATLANTA GA
30374-2057
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW ARSENAULT
Title or Position: CFO
Credential:
Phone: 786-662-7111