MEDICARE: ST JUDE MEDICAL GROUP CORP

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1356167365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JUDE MEDICAL GROUP CORP

Provider Business Mailing Address
First Line	:	2141 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3483
Country	:	US
Telephone Number	:	786-464-5120
Fax Number	:	786-464-5125

Provider Business Practice Location Address
First Line	:	6109 PEMBROKE RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-2213
Country	:	US
Telephone Number	:	954-239-7054
Fax Number	:	786-464-5125

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MANUEL D. GONZALEZ
Credential	:	MD
Telephone Number	:	786-464-5120

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	11/25/2024

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Directions to “ST JUDE MEDICAL GROUP CORP ” Practice Location

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