MEDICARE: CORAL MEDICAL MANAGEMENT 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	261Q00000X	Clinic/Center	HCC8041	FL

General Provider Information

NPI Number	:	1528172780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL MEDICAL MANAGEMENT INC

Provider Business Mailing Address
First Line	:	2200 SW 16TH ST
Second Line	:	SUITE 224
City	:	MIAMI
State	:	FL
Zip	:	33145-2067
Country	:	US
Telephone Number	:	786-879-8795
Fax Number	:	786-863-8532

Provider Business Practice Location Address
First Line	:	2200 SW 16TH ST
Second Line	:	SUITE 224
City	:	MIAMI
State	:	FL
Zip	:	33145-2067
Country	:	US
Telephone Number	:	786-879-8795
Fax Number	:	786-863-8532

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ADELFIN ADAY
Credential	:
Telephone Number	:	786-879-8795

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/09/2008

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