MEDICARE: BAPTIST HEALTH MEDICAL PLAZA MIAMI LAKES

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	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1750755609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST HEALTH MEDICAL PLAZA MIAMI LAKES

Provider Business Mailing Address
First Line	:	14701 NW 77TH AVE
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2500
Country	:	US
Telephone Number	:	786-662-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	14701 NW 77TH AVE
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2500
Country	:	US
Telephone Number	:	786-662-0700
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. PHILIP WEIMER
Credential	:
Telephone Number	:	786-596-7992

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	11/16/2015

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