MEDICARE: INTERAMERICAN MEDICAL CENTER GROUP 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
1	207Q00000X	Family Medicine Physician

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	EU039B	OTHER	FL	PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316198583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERAMERICAN MEDICAL CENTER GROUP LLC

Provider Business Mailing Address
First Line	:	1000 NW 57TH CT STE 400
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3292
Country	:	US
Telephone Number	:	305-649-8100
Fax Number	:	305-649-8778

Provider Business Practice Location Address
First Line	:	5378 W 16 AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4300
Country	:	US
Telephone Number	:	305-820-4101
Fax Number	:	305-820-2885

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	CARLOS DE SOLO
Credential	:
Telephone Number	:	305-649-8100

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	08/15/2024

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