MEDICARE: MIAMI LAKES PEDIATRICS PLLC

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	208000000X	Pediatrics Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1861059248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI LAKES PEDIATRICS PLLC

Provider Business Mailing Address
First Line	:	14400 NW 77TH CT STE 102
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-1590
Country	:	US
Telephone Number	:	305-823-7768
Fax Number	:	305-823-2211

Provider Business Practice Location Address
First Line	:	14400 NW 77TH CT STE 102
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-1590
Country	:	US
Telephone Number	:	305-823-7768
Fax Number	:	305-823-2211

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	CRISTINA ALFONSO
Credential	:
Telephone Number	:	305-823-7768

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	04/25/2022

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Directions to “MIAMI LAKES PEDIATRICS PLLC ” Practice Location

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