MEDICARE: MAYRE URDANETA MD PA

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1447545702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYRE URDANETA MD PA

Provider Business Mailing Address
First Line	:	8060 NORTH WEST 155 STREET
Second Line	:	SUITE 201
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016
Country	:	US
Telephone Number	:	305-826-0606
Fax Number	:	305-826-0630

Provider Business Practice Location Address
First Line	:	8060 NORTH WEST 155 STREET
Second Line	:	SUITE 201
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016
Country	:	US
Telephone Number	:	305-826-0606
Fax Number	:	305-826-0630

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. MAYRE URDANETA
Credential	:	MD
Telephone Number	:	305-826-0606

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/15/2011

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