MEDICARE: JKN MEDICAL CENTER,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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1508814369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JKN MEDICAL CENTER,INC

Provider Business Mailing Address
First Line	:	7325 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2505
Country	:	US
Telephone Number	:	305-262-3551
Fax Number	:	305-262-5515

Provider Business Practice Location Address
First Line	:	7331 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2505
Country	:	US
Telephone Number	:	305-262-3551
Fax Number	:	305-262-5515

Authorized Official
Title or Position	:	OWNER
Name	:	NELSON ANZARDO-CALZADILLA
Credential	:
Telephone Number	:	305-262-3551

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/22/2020

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