MEDICARE: GM MEDICAL OFFICE 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	208D00000X	General Practice Physician

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

General Provider Information

NPI Number	:	1396791323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GM MEDICAL OFFICE INC

Provider Business Mailing Address
First Line	:	10760 W FLAGLER ST
Second Line	:	STE 11
City	:	MIAMI
State	:	FL
Zip	:	33174-4404
Country	:	US
Telephone Number	:	305-554-5144
Fax Number	:	305-554-5177

Provider Business Practice Location Address
First Line	:	10760 W FLAGLER ST
Second Line	:	STE 11
City	:	MIAMI
State	:	FL
Zip	:	33174-4404
Country	:	US
Telephone Number	:	305-554-5144
Fax Number	:	305-554-5177

Authorized Official
Title or Position	:	PRESIDENT/ OWNER
Name	:	ARIEL DURAN MONDRAGON
Credential	:	MD
Telephone Number	:	305-554-5144

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	10/29/2011

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Directions to “GM MEDICAL OFFICE INC ” Practice Location

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