MEDICARE: MAYRE URDANETA 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	ME73691	FL

General Provider Information

NPI Number	:	1336445394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYRE URDANETA MD PA

Provider Business Mailing Address
First Line	:	8060 NW 155TH ST
Second Line	:	SUITE 201
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5883
Country	:	US
Telephone Number	:	305-826-0606
Fax Number	:	305-826-0630

Provider Business Practice Location Address
First Line	:	8060 NW 155TH ST
Second Line	:	SUITE 201
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5883
Country	:	US
Telephone Number	:	305-826-0606
Fax Number	:	305-826-0630

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAYRE URDANETA
Credential	:	MD
Telephone Number	:	305-826-0606

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	02/08/2011

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