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NPI Code Detail

MEDICARE: MITCHELL GREGG M.D.

MEDICARE: MITCHELL GREGG M.D.
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
12085R0202XDiagnostic Radiology PhysicianME0018008FL

General Provider Information

NPI Number : 1366547325
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITCHELL GREGG M.D.
Provider Business Mailing Address
First Line : 5901 SW 74TH ST
Second Line : SUITE 202
City : MIAMI
State : FL
Zip : 33143-5165
Country : US
Telephone Number : 305-665-4614
Fax Number : 305-667-0239
Provider Business Practice Location Address
First Line : 9333 SW 152ND ST
Second Line :
City : VILLAGE OF PALMETTO BAY
State : FL
Zip : 33157-1778
Country : US
Telephone Number : 305-665-4614
Fax Number : 305-667-0239
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 01/07/2013

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