MEDICARE: DR. LUIS VICENTE CONCEPCION DO

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	208000000X	Pediatrics Physician	OS6876	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194765750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS VICENTE CONCEPCION DO

Provider Business Mailing Address
First Line	:	16555 NW 25TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6583
Country	:	US
Telephone Number	:	786-466-1736
Fax Number	:

Provider Business Practice Location Address
First Line	:	16555 NW 25TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6583
Country	:	US
Telephone Number	:	786-466-1736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/29/2016

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