MEDICARE: GRANADA 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1669427993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANADA MEDICAL INC

Provider Business Mailing Address
First Line	:	7307 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7307 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2505
Country	:	US
Telephone Number	:	305-265-6667
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YUSUF RAJABALEE
Credential	:
Telephone Number	:	305-265-6667

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/22/2020

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Directions to “GRANADA MEDICAL INC ” Practice Location

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