MEDICARE: MEDICAL ASSOCIATES NETWORK, LLC

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	273Y00000X	Rehabilitation Hospital Unit

General Provider Information

NPI Number	:	1093020554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL ASSOCIATES NETWORK, LLC

Provider Business Mailing Address
First Line	:	3115 W 4TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5307
Country	:	US
Telephone Number	:	305-882-1460
Fax Number	:	305-882-1465

Provider Business Practice Location Address
First Line	:	3115 W 4TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5307
Country	:	US
Telephone Number	:	305-882-1460
Fax Number	:	305-882-1465

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIC O PANTALEON
Credential	:	M.D.
Telephone Number	:	305-882-1460

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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