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General NPI Number Information
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NPI Number | 1689701302
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Entity Type | Organization
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Legal Business Name | MIAMI HIALEAH MEDICAL GROUP
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1025 E 25TH ST
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City | HIALEAH
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State | FL
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Zip | 33013-3703
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Country | US
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Telephone | 305-696-0842
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Fax | 305-696-2150
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Provider Business Mailing Address
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Address Line | 1025 E 25TH ST
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City | HIALEAH
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State | FL
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Zip | 33013-3703
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Country | US
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Telephone | 305-696-0842
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Fax | 305-696-2150
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MONICA GRINBERG
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Credential | MD
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Telephone | 305-696-0842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | WAIVED
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License Number State | FL
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