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General NPI Number Information
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NPI Number | 1942974555
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Entity Type | Organization
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Legal Business Name | MIAMI MED GROUP INC
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 12700 SW 122ND AVE SUITE 105
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City | MIAMI
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State | FL
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Zip | 33186-5271
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Country | US
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Telephone | 786-206-8521
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Fax | 786-741-2636
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Provider Business Mailing Address
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Address Line | 12700 SW 122ND AVE SUITE 105
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City | MIAMI
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State | FL
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Zip | 33186-5271
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Country | US
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Telephone | 786-206-8521
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Fax | 786-741-2636
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DILIO BRAVO
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Credential | APRN
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Telephone | 786-206-8521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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