Healthcare Provider Details

I. General information

NPI: 1821339763
Provider Name (Legal Business Name): MALCOLM GEORGE GOLDSMITH MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 NE 125TH ST
NORTH MIAMI FL
33161-5805
US

IV. Provider business mailing address

2072 NE 121ST RD
NORTH MIAMI FL
33181-3322
US

V. Phone/Fax

Practice location:
  • Phone: 305-891-8850
  • Fax: 305-891-2214
Mailing address:
  • Phone: 305-582-8102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberME24823
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberME24823
License Number StateFL

VIII. Authorized Official

Name: MALCOLM GEORGE GOLDSMITH
Title or Position: OWNER
Credential: MD
Phone: 305-582-8102