Healthcare Provider Details

I. General information

NPI: 1174443071
Provider Name (Legal Business Name): MG MEDICAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17395 N BAY RD STE 108
SUNNY ISLES BEACH FL
33160-3307
US

IV. Provider business mailing address

17395 N BAY RD STE 108
SUNNY ISLES BEACH FL
33160-3307
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-6218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARINA GAFANOVICH
Title or Position: MD
Credential:
Phone: 646-662-7574