MEDICARE: SACRE COEUR SURGICAL PL

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	2080P0205X	Pediatric Endocrinology Physician
2	208200000X	Plastic Surgery Physician	ME99835	FL

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386882322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRE COEUR SURGICAL PL

Provider Business Mailing Address
First Line	:	1101 BRICKELL AVE UNIT 310897
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33231-1245
Country	:	US
Telephone Number	:	305-662-0699
Fax Number	:	305-665-8736

Provider Business Practice Location Address
First Line	:	6705 S RED RD STE 418
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-3644
Country	:	US
Telephone Number	:	305-669-4426
Fax Number	:	305-665-8736

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH W MICHIENZI
Credential	:	MD
Telephone Number	:	305-662-0699

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	08/12/2019

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