MEDICARE: MARIO S. CUERVO MD PA

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	ME0040730	FL
2	2084P0800X	Psychiatry Physician	ME0040730	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	:	1285958355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO S. CUERVO MD PA

Provider Business Mailing Address
First Line	:	10200 SW 72 STREET
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33143
Country	:	US
Telephone Number	:	305-630-1400
Fax Number	:	800-370-1116

Provider Business Practice Location Address
First Line	:	10200 SW 72 STREET
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3033
Country	:	US
Telephone Number	:	305-630-1400
Fax Number	:	800-370-1116

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. MARIO S CUERVO
Credential	:	MD
Telephone Number	:	305-661-9598

Provider Enumeration Date	:	03/18/2010
Last Update Date	:	08/29/2014

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