MEDICARE: PHYSICIANS HEALTHCARE GROUP, INC.

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

General Provider Information

NPI Number	:	1336287986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS HEALTHCARE GROUP, INC.

Provider Business Mailing Address
First Line	:	9815 SW 114TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-4145
Country	:	US
Telephone Number	:	786-242-4656
Fax Number	:	786-242-5357

Provider Business Practice Location Address
First Line	:	9815 SW 114TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-4145
Country	:	US
Telephone Number	:	786-242-4656
Fax Number	:	786-242-5357

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AIMEE GONZALEZ
Credential	:	MD
Telephone Number	:	786-242-4656

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/22/2020

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