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General NPI Number Information
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NPI Number | 1710764154
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Entity Type | Organization
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Legal Business Name | PREMIUM HEALTHCARE PLUS LLC
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 9750 SW 24TH ST
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City | MIAMI
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State | FL
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Zip | 33165-7598
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Country | US
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Telephone | 305-265-4441
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Fax | 305-265-4844
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Provider Business Mailing Address
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Address Line | 9750 SW 24TH ST
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City | MIAMI
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State | FL
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Zip | 33165-7598
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Country | US
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Telephone | 305-746-1414
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEILA HOOVER
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Credential | MD
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Telephone | 305-458-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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