MEDICARE: PEDRO MARTINEZ-CLARK MD PA

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	207RI0011X	Interventional Cardiology Physician

General Provider Information

NPI Number	:	1730831413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDRO MARTINEZ-CLARK MD PA

Provider Business Mailing Address
First Line	:	5040 NW 7TH ST STE 750
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3490
Country	:	US
Telephone Number	:	305-301-7169
Fax Number	:	866-397-9493

Provider Business Practice Location Address
First Line	:	9999 NE 2ND AVE STE 100
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2344
Country	:	US
Telephone Number	:	305-754-1654
Fax Number	:	866-397-9443

Authorized Official
Title or Position	:	OWNER
Name	:	PEDRO O MARTINEZ-CLARK
Credential	:	MD
Telephone Number	:	305-249-5666

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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