Healthcare Provider Details

I. General information

NPI: 1023542123
Provider Name (Legal Business Name): LEONARDO MEES KNIJNIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date: 11/17/2017
Reactivation Date: 11/29/2017

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax: 305-575-7236
Mailing address:
  • Phone: 305-575-7000
  • Fax: 305-575-7236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN25323
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME143988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: