MEDICARE: MDS OF SOUTH FLORIDA PA

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	207QA0505X	Adult Medicine Physician	OS8299	FL
2	207R00000X	Internal Medicine Physician	ME52945	FL
3	207R00000X	Internal Medicine Physician	ME0071416	FL

General Provider Information

NPI Number	:	1619946837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDS OF SOUTH FLORIDA PA

Provider Business Mailing Address
First Line	:	9045 SW 87TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-2304
Country	:	US
Telephone Number	:	305-598-7715
Fax Number	:	305-598-7719

Provider Business Practice Location Address
First Line	:	9045 SW 87TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-2304
Country	:	US
Telephone Number	:	305-598-7715
Fax Number	:	305-598-7719

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	JODY BETH MALE
Credential	:
Telephone Number	:	305-598-7715

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/09/2008

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