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General NPI Number Information
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NPI Number | 1740905819
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Entity Type | Organization
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Legal Business Name | MIAMI MEDICAL ALLIANCE LLC
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 116 W BLOOMINGDALE AVE
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City | BRANDON
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State | FL
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Zip | 33511-7430
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Country | US
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Telephone | 201-566-2479
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Fax |
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Provider Business Mailing Address
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Address Line | 2729 STATE ROAD 580
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City | CLEARWATER
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State | FL
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Zip | 33761-3358
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP OF BUSINESS DEVELOPMENT
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Name | DYLAN FIELD
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Credential |
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Telephone | 201-566-2479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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