MEDICARE: KEYSTONE MEDICAL 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	261QP2300X	Primary Care Clinic/Center	ME77120	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598171266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE MEDICAL INC

Provider Business Mailing Address
First Line	:	13499 BISCAYNE BLVD
Second Line	:	SUITE M6-M7
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2043
Country	:	US
Telephone Number	:	305-956-2728
Fax Number	:	305-940-6201

Provider Business Practice Location Address
First Line	:	13499 BISCAYNE BLVD
Second Line	:	SUITE M6-M7
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2043
Country	:	US
Telephone Number	:	305-956-2728
Fax Number	:	305-940-6201

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. RONALD J DORTONNE
Credential	:
Telephone Number	:	305-323-0354

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	07/02/2014

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Directions to “KEYSTONE MEDICAL INC ” Practice Location

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