MEDICARE: COMFORT MEDICAL CENTER 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1740527571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	719 NW 29TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-3828
Country	:	US
Telephone Number	:	305-603-8200
Fax Number	:	305-603-8461

Provider Business Practice Location Address
First Line	:	719 NW 29TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-3828
Country	:	US
Telephone Number	:	305-603-8200
Fax Number	:	305-603-8461

Authorized Official
Title or Position	:	MGRM
Name	:	EPHRAIN CABAN JR.
Credential	:	M.D.
Telephone Number	:	305-603-8200

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	01/14/2013

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