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NPI Code Detail

MEDICARE: CONVIVA MEDICAL CENTER MANAGEMENT LLC

MEDICARE: CONVIVA MEDICAL CENTER MANAGEMENT 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
1207R00000XInternal Medicine Physician
2208D00000XGeneral Practice Physician
3207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1174480735
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONVIVA MEDICAL CENTER MANAGEMENT LLC
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number : 305-500-2000
Fax Number :
Provider Business Practice Location Address
First Line : 5801 MIAMI LAKES DR
Second Line :
City : MIAMI LAKES
State : FL
Zip : 33014-2401
Country : US
Telephone Number : 786-756-7180
Fax Number :
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : MEGAN GALVAN
Credential :
Telephone Number : 305-500-2000
Provider Enumeration Date : 01/06/2026
Last Update Date : 01/06/2026

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Directions to “CONVIVA MEDICAL CENTER MANAGEMENT LLC ” Practice Location

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