| Mgm Ipa Dade 001 LLC | |
|
8318 Sw 193rd St Cutler Bay FL 33157-8085 | |
| (305) 964-5119 | |
| Not Available |
| Full Name | Mgm Ipa Dade 001 LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 8318 Sw 193rd St, Cutler Bay, Florida |
| Authorized Official Name and Position | Mario Armando Espino (CEO/PRESIDENT) |
| Authorized Official Contact | 7863951165 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mgm Ipa Dade 001 LLC 8318 Sw 193rd St Cutler Bay FL 33157-8085 Ph: (305) 964-5119 | Mgm Ipa Dade 001 LLC 8318 Sw 193rd St Cutler Bay FL 33157-8085 Ph: (305) 964-5119 |
| NPI Number | 1619303112 |
|---|---|
| Provider Enumeration Date | 09/17/2013 |
| Last Update Date | 09/17/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619303112 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| 208D00000X | General Practice | () | Secondary |
| 302F00000X | Exclusive Provider Organization | () | Secondary |
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