=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669541967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIAMI ONCOLOGY INSTITUTE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 06/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 747 PONCE DE LEON BLVD STE 503A
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-261-9293
-----------------------------------------------------
Fax | 305-446-6078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 747 PONCE DE LEON BLVD SUITE 503A
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-261-9293
-----------------------------------------------------
Fax | 305-446-6078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EDUARDO ENRIQUE ACLE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-261-9293
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | ME31968
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------