MEDICARE: INDEPENDENT FAMILY PRACTICE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	305S00000X	Point of Service
3	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1134535891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT FAMILY PRACTICE CORPORATION

Provider Business Mailing Address
First Line	:	17500 NE 9TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2123
Country	:	US
Telephone Number	:	518-813-0007
Fax Number	:	425-871-0007

Provider Business Practice Location Address
First Line	:	17500 NE 9TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2123
Country	:	US
Telephone Number	:	518-813-0007
Fax Number	:	425-871-0007

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH TEMPELBERG
Credential	:
Telephone Number	:	518-813-0007

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	07/02/2014

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