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General NPI Number Information
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NPI Number | 1174061311
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Entity Type | Organization
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Legal Business Name | MCIC PHYSICIANS IPA GROUP
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 40 EXCHANGE PL STE 601
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City | NEW YORK
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State | NY
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Zip | 10005-2772
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Country | US
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Telephone | 786-554-1151
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 PONCE DE LEON BLVD # 500
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City | CORAL GABLES
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State | FL
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Zip | 33134-4418
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Country | US
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Telephone | 786-554-1151
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VICTOR BEHAR
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Credential |
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Telephone | 786-554-1151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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