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NPI Code Detail

MEDICARE: UNIVERSITY HEALTH CARE RED ROAD INC.

MEDICARE: UNIVERSITY HEALTH CARE RED ROAD INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1043513997
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY HEALTH CARE RED ROAD INC.
Provider Business Mailing Address
First Line : 3695 W 4TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-4300
Country : US
Telephone Number : 305-207-4443
Fax Number : 305-207-4442
Provider Business Practice Location Address
First Line : 3695 W 4TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-4300
Country : US
Telephone Number : 305-207-4443
Fax Number : 305-207-4442
Authorized Official
Title or Position : VICE PRESIDENT
Name : MR. MICHAEL QUEVEDO
Credential :
Telephone Number : 305-207-4443
Provider Enumeration Date : 12/15/2010
Last Update Date : 12/15/2010

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Directions to “UNIVERSITY HEALTH CARE RED ROAD INC. ” Practice Location

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