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General NPI Number Information
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NPI Number | 1003938374
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Entity Type | Organization
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Legal Business Name | POLINA NOSEL MD,PA
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Dates
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Enumeration Date | 04/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1380 NE MIAMI GARDENS DR SUITE 275
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City | MIAMI
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State | FL
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Zip | 33179-4707
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Country | US
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Telephone | 305-945-8111
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Fax | 305-945-8186
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Provider Business Mailing Address
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Address Line | 1380 NE MIAMI GARDENS DR SUITE 275
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City | MIAMI
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State | FL
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Zip | 33179-4707
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Country | US
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Telephone | 305-945-8111
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Fax | 305-945-8186
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. INNA BARANOVICH
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Credential |
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Telephone | 305-945-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME76939
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License Number State | FL
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