MEDICARE: DR. ENRIQUE J VICIANA MD

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	174400000X	Specialist	0057841	FL

General Provider Information

NPI Number	:	1265495956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENRIQUE J VICIANA MD

Provider Business Mailing Address
First Line	:	9155 S DADELAND BLVD
Second Line	:	SUITE 1404
City	:	MIAMI
State	:	FL
Zip	:	33156-2737
Country	:	US
Telephone Number	:	305-663-9933
Fax Number	:	305-671-2390

Provider Business Practice Location Address
First Line	:	9155 S DADELAND BLVD
Second Line	:	SUITE 1404
City	:	MIAMI
State	:	FL
Zip	:	33156-2737
Country	:	US
Telephone Number	:	305-663-9933
Fax Number	:	305-671-2390

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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