MEDICARE: DOUGLAS GARDENS AT CORAL WAY 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	127	FL

General Provider Information

NPI Number	:	1952584377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS GARDENS AT CORAL WAY INC

Provider Business Mailing Address
First Line	:	5200 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-2706
Country	:	US
Telephone Number	:	305-762-1393
Fax Number	:	305-762-1488

Provider Business Practice Location Address
First Line	:	1757 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-2728
Country	:	US
Telephone Number	:	305-854-2555
Fax Number	:	305-854-4411

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. MARK T KNIGHT
Credential	:
Telephone Number	:	305-762-1393

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/07/2007

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