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General NPI Number Information
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NPI Number | 1568726636
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Entity Type | Organization
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Legal Business Name | CPC MEDICAL CENTER@MILLER DRIVE
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 10240 SW 56TH ST 106
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City | MIAMI
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State | FL
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Zip | 33165-7071
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Country | US
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Telephone | 305-598-8805
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Fax |
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Provider Business Mailing Address
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Address Line | 10240 SW 56TH ST 106
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City | MIAMI
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State | FL
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Zip | 33165-7071
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Country | US
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Telephone | 305-598-8805
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | RICHARD CHERVONY
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Credential |
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Telephone | 305-854-6661
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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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