MEDICARE: MIAMI COMPREHENSIVE MEDICINE GROUP PA

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1104101666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI COMPREHENSIVE MEDICINE GROUP PA

Provider Business Mailing Address
First Line	:	345 PALERMO AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6607
Country	:	US
Telephone Number	:	305-851-2870
Fax Number	:	305-851-2871

Provider Business Practice Location Address
First Line	:	4685 PONCE DE LEON BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2108
Country	:	US
Telephone Number	:	305-851-2870
Fax Number	:	305-851-2871

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HEATHER L MASON
Credential	:	MD
Telephone Number	:	305-851-2870

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	05/29/2024

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