Healthcare Provider Details

I. General information

NPI: 1073692505
Provider Name (Legal Business Name): COURTESY MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 W FLAGLER ST SUITE 3D
MIAMI FL
33144-2100
US

IV. Provider business mailing address

8080 W FLAGLER ST SUITE 3D
MIAMI FL
33144-2100
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-8252
  • Fax: 305-262-4122
Mailing address:
  • Phone: 305-262-8252
  • Fax: 305-262-4122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number363AM0700X
License Number StateFL

VIII. Authorized Official

Name: MRS. TERESA CAYRO
Title or Position: PRESIDENT
Credential:
Phone: 305-262-8252