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NPI Code Detail

MEDICARE: PATAKY MEDICAL CENTER INC

MEDICARE: PATAKY MEDICAL CENTER 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 PhysicianHCC10449FL
2207Q00000XFamily Medicine PhysicianHCC10449FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1K8416AOTHERFLPTAN

General Provider Information

NPI Number : 1114988151
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATAKY MEDICAL CENTER INC
Provider Business Mailing Address
First Line : 12781 SW 42ND ST
Second Line : SUITE G
City : MIAMI
State : FL
Zip : 33175-3437
Country : US
Telephone Number : 305-553-2220
Fax Number : 305-553-9753
Provider Business Practice Location Address
First Line : 12781 SW 42ND ST
Second Line : SUITE G
City : MIAMI
State : FL
Zip : 33175-3437
Country : US
Telephone Number : 305-553-2220
Fax Number : 305-553-9753
Authorized Official
Title or Position : PRESIDENT
Name : CARMEN ZILIA OLIVA
Credential : LPN
Telephone Number : 305-553-2220
Provider Enumeration Date : 03/29/2006
Last Update Date : 02/16/2016

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Directions to “PATAKY MEDICAL CENTER INC ” Practice Location

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