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General NPI Number Information
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NPI Number | 1952027104
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Entity Type | Organization
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Legal Business Name | WATERWAY MED GROUP LLC
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 7001 N WATERWAY DR STE 107
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City | MIAMI
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State | FL
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Zip | 33155-2827
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Country | US
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Telephone | 786-542-9832
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Fax | 786-685-2585
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Provider Business Mailing Address
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Address Line | 7001 N WATERWAY DR STE 107
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City | MIAMI
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State | FL
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Zip | 33155-2827
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Country | US
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Telephone | 786-542-9832
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Fax | 786-685-2585
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JESUS URGELLES
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Credential |
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Telephone | 786-542-9832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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