Healthcare Provider Details

I. General information

NPI: 1346356847
Provider Name (Legal Business Name): BIRD RD MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8485 SW 40TH STREET 102
MIAMI FL
33155-3262
US

IV. Provider business mailing address

8485 SW 40TH STREET 102
MIAMI FL
33155-3262
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-3412
  • Fax: 305-551-1945
Mailing address:
  • Phone: 305-551-3412
  • Fax: 305-551-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DORA Q REYES
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 305-551-3412