=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235423252
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE GARDINER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2011
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 975 W 41ST ST STE 211
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-3341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-538-1188
-----------------------------------------------------
Fax | 305-907-5832
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1521 ALTON RD STE 633
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33139-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-992-8932
-----------------------------------------------------
Fax | 305-907-5832
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME109596
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------