MEDICARE: ENDOPRIME, 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME0057020	FL

General Provider Information

NPI Number	:	1689913824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDOPRIME, LLC

Provider Business Mailing Address
First Line	:	13055 SW 42ND ST STE 105
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3409
Country	:	US
Telephone Number	:	305-207-2500
Fax Number	:	305-207-2400

Provider Business Practice Location Address
First Line	:	13055 SW 42ND ST STE 105
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3409
Country	:	US
Telephone Number	:	305-207-2500
Fax Number	:	305-207-2400

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRANCISCO OMAR HERNANDEZ
Credential	:	MD
Telephone Number	:	305-207-2500

Provider Enumeration Date	:	02/07/2013
Last Update Date	:	02/07/2013

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Directions to “ENDOPRIME, LLC ” Practice Location

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