Healthcare Provider Details

I. General information

NPI: 1891466264
Provider Name (Legal Business Name): BMC MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 SW 120TH ST STE 103
MIAMI FL
33186-7662
US

IV. Provider business mailing address

14221 SW 120TH ST STE 214
MIAMI FL
33186-4224
US

V. Phone/Fax

Practice location:
  • Phone: 305-517-3000
  • Fax: 53-517-1293
Mailing address:
  • Phone: 786-206-8700
  • Fax: 786-206-8701

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: MARIO R MENDEZ
Title or Position: MANAGER
Credential:
Phone: 786-295-0479