Healthcare Provider Details

I. General information

NPI: 1669504767
Provider Name (Legal Business Name): CPC MEDICAL CENTER AT MILLER DRIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 SW 56TH ST SUITE #106
MIAMI FL
33165-7071
US

IV. Provider business mailing address

2455 SW 27TH AVE SUITE 100
MIAMI FL
33145-3663
US

V. Phone/Fax

Practice location:
  • Phone: 305-598-8805
  • Fax: 305-598-8109
Mailing address:
  • Phone: 305-854-6661
  • Fax: 305-856-6954

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: MR. RICHARD CHERVONY
Title or Position: VICE PRESIDENT
Credential:
Phone: 305-854-6661