=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609657808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M&V MEDICAL GROUP PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2023
-----------------------------------------------------
Last Update Date | 10/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 E HALLANDALE BEACH BLVD STE 609
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-333-8665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 E HALLANDALE BEACH BLVD STE 609
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-333-8665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MIRA ZEITLIN
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 954-608-4586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------