MEDICARE: INTEGRA HEALTH LLC

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1528705084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRA HEALTH LLC

Provider Business Mailing Address
First Line	:	4401 ROYAL PALM AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3039
Country	:	US
Telephone Number	:	917-596-9387
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 ROYAL PALM AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3039
Country	:	US
Telephone Number	:	917-596-9387
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/ OWNER
Name	:	YORAM GUTFREUND
Credential	:	MD
Telephone Number	:	917-596-9387

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	05/17/2022

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