Healthcare Provider Details

I. General information

NPI: 1992027486
Provider Name (Legal Business Name): PERSONAL CARE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NE 167 STREET
NORTH MIAMI BEACH FL
33162
US

IV. Provider business mailing address

1 NE 167 STREET
NORTH MIAMI BEACH FL
33162
US

V. Phone/Fax

Practice location:
  • Phone: 305-432-9565
  • Fax: 305-432-9567
Mailing address:
  • Phone: 305-432-9565
  • Fax: 305-432-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. ROBBIE CHAMOUN
Title or Position: OWNER
Credential:
Phone: 786-317-2377