MEDICARE: NANGI SHORES MEDICAL GROUP

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
1	172V00000X	Community Health Worker	ME85072	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1356311822	OTHER	FL	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063769412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANGI SHORES MEDICAL GROUP

Provider Business Mailing Address
First Line	:	9999 NE 2ND AVE STE 214
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2345
Country	:	US
Telephone Number	:	305-384-8789
Fax Number	:	786-953-4169

Provider Business Practice Location Address
First Line	:	9999 NE 2ND AVE STE 214
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2345
Country	:	US
Telephone Number	:	305-384-8789
Fax Number	:	786-953-4169

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ALPHONSE G DUFRENY
Credential	:	M.D.
Telephone Number	:	305-756-9392

Provider Enumeration Date	:	08/04/2012
Last Update Date	:	08/04/2012

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Directions to “NANGI SHORES MEDICAL GROUP ” Practice Location

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