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General NPI Number Information
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NPI Number | 1114221033
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF FLORIDA MEDICAL, P.A.
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Dates
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Enumeration Date | 01/06/2011
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 4200 W FLAGLER ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-1606
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Country | US
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Telephone | 305-569-4125
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Fax | 305-569-4124
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Provider Business Mailing Address
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Address Line | 5500 MARYLAND WAY
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City | BRENTWOOD
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State | TN
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Zip | 37027-4948
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Country | US
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Telephone | 877-865-9013
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Fax | 305-569-4124
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN LEIZMAN
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Credential | MD
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Telephone | 216-479-9063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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