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General NPI Number Information
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NPI Number | 1477996544
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Entity Type | Organization
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Legal Business Name | MIVIP MEDICAL GROUP INC
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 351 NW 42ND AVE SUITE 408
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City | MIAMI
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State | FL
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Zip | 33126-5683
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Country | US
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Telephone | 561-392-3341
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Fax |
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Provider Business Mailing Address
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Address Line | 398 CAMINO GARDENS BLVD SUITE 102
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City | BOCA RATON
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State | FL
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Zip | 33432-5827
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Country | US
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Telephone | 561-392-3341
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Fax |
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Authorized Official
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Title or Position | OWBER
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Name | ISAAC VERBUKH
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Credential | MD
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Telephone | 561-392-3341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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