Healthcare Provider Details

I. General information

NPI: 1003021296
Provider Name (Legal Business Name): MADORSKY, PINON, BRUCK & MENNIE UROLOGY CENTER OF SOUTH FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 SW 87TH AVE SUITE 240
MIAMI FL
33173-5458
US

IV. Provider business mailing address

7400 SW 87TH AVE SUITE 240
MIAMI FL
33173-5458
US

V. Phone/Fax

Practice location:
  • Phone: 305-270-6010
  • Fax: 305-598-7754
Mailing address:
  • Phone: 305-270-6010
  • Fax: 305-598-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA DELCARMEN LOPEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-270-6010