MEDICARE: PHYCARE NETWORK LLC

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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1437596137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYCARE NETWORK LLC

Provider Business Mailing Address
First Line	:	9415 NE 6TH AVE
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138
Country	:	US
Telephone Number	:	305-389-7018
Fax Number	:

Provider Business Practice Location Address
First Line	:	9415 NE 6TH AVE
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2737
Country	:	US
Telephone Number	:	305-389-7018
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ISABELLE DIAZ
Credential	:
Telephone Number	:	305-389-7018

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	06/04/2013

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Directions to “PHYCARE NETWORK LLC ” Practice Location

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