MEDICARE: MEDICAL GLOBAL CENTER 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	207Q00000X	Family Medicine Physician	HCC7628	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5825103	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1588793715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL GLOBAL CENTER INC

Provider Business Mailing Address
First Line	:	4401 SW 8TH ST
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2540
Country	:	US
Telephone Number	:	305-643-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 SW 8TH ST
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2540
Country	:	US
Telephone Number	:	305-643-6565
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROMILIO N LORITES
Credential	:
Telephone Number	:	305-643-6565

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	02/29/2008

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