Healthcare Provider Details

I. General information

NPI: 1134686967
Provider Name (Legal Business Name): SOUTHERN FLORIDA HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BRICKELL KEY DR STE 700
MIAMI FL
33131-2649
US

IV. Provider business mailing address

5927 SW 70TH ST # 439031
MIAMI FL
33143-2707
US

V. Phone/Fax

Practice location:
  • Phone: 305-982-1340
  • Fax: 305-666-1065
Mailing address:
  • Phone: 305-666-2427
  • Fax: 305-666-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT EMMETT MCKITTRICK
Title or Position: MGR
Credential: MD
Phone: 305-982-1340