MEDICARE: ALICE W HERNANDEZ-BEM M.D.

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	208D00000X	General Practice Physician	39574	MA

General Provider Information

NPI Number	:	1205875291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE W HERNANDEZ-BEM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 144598
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33114-4598
Country	:	US
Telephone Number	:	305-949-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 NE 164TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4018
Country	:	US
Telephone Number	:	305-949-2000
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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