MEDICARE: PROMED MEDICAL SUPPLIES INC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1861950149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMED MEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	1400 NE MIAMI GARDENS DR STE 206B
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-4840
Country	:	US
Telephone Number	:	305-428-2048
Fax Number	:	888-600-9557

Provider Business Practice Location Address
First Line	:	1400 NE MIAMI GARDENS DR STE 206B
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-4840
Country	:	US
Telephone Number	:	305-428-2048
Fax Number	:	888-600-9557

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAFAEL ISKHAKOV
Credential	:
Telephone Number	:	305-428-2048

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	03/06/2019

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