MEDICARE: DR. ALFONSO JOSE MONGE M.D.

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	207R00000X	Internal Medicine Physician	ME0071416	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K0849	OTHER	FL	GROUP MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720057987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFONSO JOSE MONGE M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	10/20/2022

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