=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871995746
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIKI & ALFONSO HAND & UPPER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2014
-----------------------------------------------------
Last Update Date | 07/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9765 SW 184TH ST
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-6932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-308-0210
-----------------------------------------------------
Fax | 305-273-2176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 566262
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33256-6262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-333-7367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. ROBERTO AUGUSTO MIKI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-333-7367
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | ME98778
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------