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General NPI Number Information
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NPI Number | 1093871568
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Entity Type | Organization
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Legal Business Name | NORTH SHORE EKG ASSOCIATES INC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 1100 NW 95TH ST
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City | MIAMI
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State | FL
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Zip | 33150-2038
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Country | US
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Telephone | 305-665-4614
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Fax | 305-667-0239
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Provider Business Mailing Address
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Address Line | 5927 SW 70TH ST # 439031
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3527
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Country | US
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Telephone | 305-665-4614
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Fax | 305-667-0239
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOSE CENTURION
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Credential | M.D.
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Telephone | 305-665-4614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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