MEDICARE: DR. CYNTHIA D WIRTH 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	0059102	FL

General Provider Information

NPI Number	:	1821039462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA D WIRTH M.D.

Provider Business Mailing Address
First Line	:	2657 NE 164TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4011
Country	:	US
Telephone Number	:	305-944-2105
Fax Number	:	305-944-2106

Provider Business Practice Location Address
First Line	:	3966 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6291
Country	:	US
Telephone Number	:	305-430-9499
Fax Number	:	305-474-0899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	05/24/2012

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