MEDICARE: GOLDEN MULTISPECIALTY GROUP

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	207Q00000X	Family Medicine Physician		FL
2	208VP0014X	Interventional Pain Medicine Physician		FL

General Provider Information

NPI Number	:	1417297375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN MULTISPECIALTY GROUP

Provider Business Mailing Address
First Line	:	3966 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6291
Country	:	US
Telephone Number	:	305-625-7504
Fax Number	:

Provider Business Practice Location Address
First Line	:	3966 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6291
Country	:	US
Telephone Number	:	305-625-7504
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES C PADULA
Credential	:	D.O.
Telephone Number	:	305-625-7504

Provider Enumeration Date	:	02/28/2013
Last Update Date	:	02/28/2013

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