MEDICARE: MICNADY MEDICAL OFFICE 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

General Provider Information

NPI Number	:	1538416557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICNADY MEDICAL OFFICE INC

Provider Business Mailing Address
First Line	:	8820 SW 24TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-2008
Country	:	US
Telephone Number	:	786-391-0264
Fax Number	:	786-391-0276

Provider Business Practice Location Address
First Line	:	8820 SW 24TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-2008
Country	:	US
Telephone Number	:	786-391-0264
Fax Number	:	786-391-0276

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LUCKY FLORES
Credential	:	M.D.
Telephone Number	:	786-391-0264

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/09/2012

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Directions to “MICNADY MEDICAL OFFICE INC ” Practice Location

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