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General NPI Number Information
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NPI Number | 1982204616
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA MULTI-SPECIALTY MEDICAL GROUP LLC
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 475 BILTMORE WAY STE 205
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City | CORAL GABLES
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State | FL
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Zip | 33134-5736
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Country | US
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Telephone | 833-735-3668
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Fax | 866-897-7014
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Provider Business Mailing Address
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Address Line | 8950 SW 74TH CT STE 1408
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City | MIAMI
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State | FL
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Zip | 33156-3173
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Country | US
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Telephone | 833-735-3668
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Fax | 866-897-7014
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. PETER HANY HANNA
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Credential | DPM
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Telephone | 973-900-1198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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