MEDICARE: SOUTHSIDE OB-GYN PLLC

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	207V00000X	Obstetrics & Gynecology Physician	ME108552	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	:	1427322882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHSIDE OB-GYN PLLC

Provider Business Mailing Address
First Line	:	6464 N MIAMI AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33150-4520
Country	:	US
Telephone Number	:	786-657-2269
Fax Number	:	786-955-6972

Provider Business Practice Location Address
First Line	:	6464 N MIAMI AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33150-4520
Country	:	US
Telephone Number	:	786-657-2269
Fax Number	:	786-955-6972

Authorized Official
Title or Position	:	MD
Name	:	EDY AMISIAL
Credential	:	MD
Telephone Number	:	786-657-2269

Provider Enumeration Date	:	03/02/2012
Last Update Date	:	11/24/2025

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Directions to “SOUTHSIDE OB-GYN PLLC ” Practice Location

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