Healthcare Provider Details

I. General information

NPI: 1245317023
Provider Name (Legal Business Name): ADVANCE HEALTH MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 N.E 163 STREET SUITE 206
NORTH MIAMI FL
33068
US

IV. Provider business mailing address

2040 N. E 163 STREET SUITE 206
NORTH MIAMI FL
33163
US

V. Phone/Fax

Practice location:
  • Phone: 305-405-6464
  • Fax: 305-405-6461
Mailing address:
  • Phone: 305-405-6464
  • Fax: 305-405-6449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0001X
TaxonomyClinical & Laboratory Immunology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HUBERT LAJEUNE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 305-405-6461