MEDICARE: DR. INGRID SOLOMON 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	261QU0200X	Urgent Care Clinic/Center	OS8956	FL
2	261Q00000X	Clinic/Center	OS8956	FL

General Provider Information

NPI Number	:	1518107713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. INGRID SOLOMON INC.

Provider Business Mailing Address
First Line	:	2821 NE 163RD ST APT 3J
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4430
Country	:	US
Telephone Number	:	305-949-2158
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 NE 163RD ST APT 3J
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4430
Country	:	US
Telephone Number	:	305-949-2158
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. INGRID PATRICIA SOLOMON
Credential	:	D.O.
Telephone Number	:	305-949-2158

Provider Enumeration Date	:	02/27/2009
Last Update Date	:	02/27/2009

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