Healthcare Provider Details

I. General information

NPI: 1750770509
Provider Name (Legal Business Name): NORTH MIAMI VASCULAR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 NE MIAMI GARDENS DR SUITE 240
NORTH MIAMI BEACH FL
33179-4707
US

IV. Provider business mailing address

9140 CORSEA DEL FONTANA WAY
NAPLES FL
34109-4397
US

V. Phone/Fax

Practice location:
  • Phone: 305-907-6191
  • Fax: 305-907-6192
Mailing address:
  • Phone: 239-597-2010
  • Fax: 239-597-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA MCNAMARA
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 239-597-2010