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General NPI Number Information
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NPI Number | 1992076681
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Entity Type | Organization
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Legal Business Name | MIAMI RHEUMATOLOGY, LLC
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Dates
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Enumeration Date | 01/26/2012
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 715 SW 73RD AVE
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City | MIAMI
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State | FL
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Zip | 33144-2635
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Country | US
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Telephone | 305-250-9998
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Fax | 305-250-9975
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Provider Business Mailing Address
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Address Line | 715 SW 73RD AVE
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City | MIAMI
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State | FL
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Zip | 33144-2635
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Country | US
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Telephone | 305-250-9998
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Fax | 305-250-9975
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Authorized Official
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Title or Position | MANAGER
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Name | DR. REUVEN BROMBERG
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Credential | MD
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Telephone | 305-250-9998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0216X
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Taxonomy Name | Pediatric Rheumatology Physician
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License Number | ME111299
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | ME111299
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License Number State | FL
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