MEDICARE: METROMED OF MIAMI, 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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center	ME57645	FL

General Provider Information

NPI Number	:	1558316307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROMED OF MIAMI, INC

Provider Business Mailing Address
First Line	:	12510 N KENDALL DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1817
Country	:	US
Telephone Number	:	305-279-1515
Fax Number	:	305-279-1219

Provider Business Practice Location Address
First Line	:	12510 N KENDALL DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1817
Country	:	US
Telephone Number	:	305-279-1515
Fax Number	:	305-279-1219

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	OSCAR L HERNANDEZ
Credential	:	MD
Telephone Number	:	305-279-1515

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	06/02/2010

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