MEDICARE: BISCAYNE WELLNESS MEDICAL INSTITUTE, INC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1467681445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BISCAYNE WELLNESS MEDICAL INSTITUTE, INC

Provider Business Mailing Address
First Line	:	13899 BISCAYNE BLVD
Second Line	:	SUITE 155
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33181-1600
Country	:	US
Telephone Number	:	305-816-6733
Fax Number	:	305-808-3416

Provider Business Practice Location Address
First Line	:	13899 BISCAYNE BLVD
Second Line	:	SUITE 155
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33181-1600
Country	:	US
Telephone Number	:	305-816-6733
Fax Number	:	305-808-3416

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MARIE CARMEL DOSSOUS
Credential	:
Telephone Number	:	954-274-0847

Provider Enumeration Date	:	07/10/2009
Last Update Date	:	07/10/2009

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