=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639467103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUELLETTE GROUP PHYSICIANS FOR THE HAND
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2011
-----------------------------------------------------
Last Update Date | 06/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3150 SW 38 AVE SUITE 600
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-1523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-261-0222
-----------------------------------------------------
Fax | 786-594-4650
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3150 SW 38 AVE SUITE 600
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-1523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-261-0222
-----------------------------------------------------
Fax | 786-594-4650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIZABETH A OUELLETTE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-261-0222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME42477
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------