MEDICARE: PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1629647995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA

Provider Business Mailing Address
First Line	:	PO BOX 12493
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33101-2493
Country	:	US
Telephone Number	:	786-466-8101
Fax Number	:

Provider Business Practice Location Address
First Line	:	15155 SW 97TH AVE STE 230
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-7016
Country	:	US
Telephone Number	:	305-585-5259
Fax Number	:

Authorized Official
Title or Position	:	EVP CHEIF FINANCIAL OFFICER
Name	:	MARK T KNIGHT
Credential	:
Telephone Number	:	305-585-7979

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	06/22/2021

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