Healthcare Provider Details

I. General information

NPI: 1679964555
Provider Name (Legal Business Name): METCARE OF FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 SE INDIAN ST SUITE 103
STUART FL
34997-5689
US

IV. Provider business mailing address

6101 BLUE LAGOON DR SUITE 400
MIAMI FL
33126-2055
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-0552
  • Fax: 772-286-7574
Mailing address:
  • Phone: 305-500-2114
  • Fax: 305-370-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GEMMA ROSELLO
Title or Position: V.P. OPEARATIONS
Credential:
Phone: 305-500-2000