MEDICARE: CONCIERGE PEDIATRICS MIAMI BEACH, LLC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1669166559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCIERGE PEDIATRICS MIAMI BEACH, LLC

Provider Business Mailing Address
First Line	:	2115 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8815
Country	:	US
Telephone Number	:	727-688-8515
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 W 41ST ST UNIT 406
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3504
Country	:	US
Telephone Number	:	305-239-3119
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MICHAEL CIBRAN
Credential	:
Telephone Number	:	276-888-5157

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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