MEDICARE: MCD 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1972714384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCD MEDICAL CORP

Provider Business Mailing Address
First Line	:	10550 NW 77TH CT
Second Line	:	SUITE 224
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-7084
Country	:	US
Telephone Number	:	305-825-2303
Fax Number	:

Provider Business Practice Location Address
First Line	:	10550 NW 77TH CT
Second Line	:	SUITE 224
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-7084
Country	:	US
Telephone Number	:	305-825-2303
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NIVIO D LAGUARDIA
Credential	:
Telephone Number	:	305-825-2303

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	08/22/2020

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Directions to “MCD MEDICAL CORP ” Practice Location

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