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General NPI Number Information
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NPI Number | 1619331808
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Entity Type | Organization
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Legal Business Name | SOUTHERN FLORIDA MEDICAL GROUP
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 6399 SW 120TH ST
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City | MIAMI
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State | FL
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Zip | 33156-4832
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Country | US
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Telephone | 305-519-1447
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Fax |
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Provider Business Mailing Address
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Address Line | 3657 MADACA LN
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City | TAMPA
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State | FL
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Zip | 33618-2048
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Country | US
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Telephone | 586-243-5225
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | GAMAL WAZNI
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Credential | MD
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Telephone | 586-243-5225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME95736
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License Number State | FL
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