MEDICARE: HIALEAH MEDICAL ASSOCIATES, 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
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104984236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIALEAH MEDICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	8074 NW 103RD ST
Second Line	:	SUITE 20
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2256
Country	:	US
Telephone Number	:	305-826-4307
Fax Number	:	305-826-6790

Provider Business Practice Location Address
First Line	:	8074 NW 103RD ST
Second Line	:	SUITE 20
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2256
Country	:	US
Telephone Number	:	305-826-4307
Fax Number	:	305-826-6790

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HEIDI GONZALEZ
Credential	:
Telephone Number	:	305-826-4307

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	04/12/2014

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