MEDICARE: MEDIGEM CORP

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	332B00000X	Durable Medical Equipment & Medical Supplies		FL

General Provider Information

NPI Number	:	1457384679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIGEM CORP

Provider Business Mailing Address
First Line	:	1799 NE 164TH ST STE 105
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4049
Country	:	US
Telephone Number	:	305-944-3354
Fax Number	:	305-944-5996

Provider Business Practice Location Address
First Line	:	1799 NE 164TH ST STE 105
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4049
Country	:	US
Telephone Number	:	305-944-3354
Fax Number	:	305-944-5996

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANDRA HERNANDEZ
Credential	:
Telephone Number	:	305-944-3354

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	11/01/2007

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Directions to “MEDIGEM CORP ” Practice Location

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