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General NPI Number Information
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NPI Number | 1154611036
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Entity Type | Organization
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Legal Business Name | SAVICO MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 18356 NW 47TH AVE
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-2934
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Country | US
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Telephone | 305-974-5750
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Fax | 305-757-4443
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Provider Business Mailing Address
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Address Line | 17439 NW 66TH CT
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City | HIALEAH
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State | FL
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Zip | 33015-4431
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Country | US
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Telephone | 305-974-5750
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Fax | 305-757-4443
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN DIRECTOR/OWNER
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Name | DR. COMFORT OMOBOLA ADEWUMI
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Credential | D.O.
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Telephone | 305-757-4442
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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 | OS8579
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License Number State | FL
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