MEDICARE: MD MEDICAL CORP.

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	173000000X	Legal Medicine

General Provider Information

NPI Number	:	1902857378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD MEDICAL CORP.

Provider Business Mailing Address
First Line	:	8150 SW 8TH ST
Second Line	:	SUITE 104
City	:	MIAMI
State	:	FL
Zip	:	33144-4263
Country	:	US
Telephone Number	:	305-267-2707
Fax Number	:	954-987-1355

Provider Business Practice Location Address
First Line	:	8150 SW 8TH ST
Second Line	:	SUITE 104
City	:	MIAMI
State	:	FL
Zip	:	33144-4263
Country	:	US
Telephone Number	:	305-267-2707
Fax Number	:	954-987-1355

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL NIETO
Credential	:
Telephone Number	:	305-267-2707

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/22/2020

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