Healthcare Provider Details

I. General information

NPI: 1043395460
Provider Name (Legal Business Name): PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1500 NW 12TH AVE JACKSON MEDICAL TOWERS SUITE 1129
MIAMI FL
33136-1051
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8957
  • Fax: 305-585-5259
Mailing address:
  • Phone: 305-585-8957
  • Fax: 585-585-5259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK T KNIGHT
Title or Position: EXECUTIVE VP, CFO
Credential:
Phone: 305-585-7137