| Miami Lakes Medical Center Associates, P.a. | |
|
7150 W 20th Ave Suite 315 Hialeah FL 33016-5529 | |
| (305) 821-6600 | |
| (305) 821-0773 |
| Full Name | Miami Lakes Medical Center Associates, P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 7150 W 20th Ave, Hialeah, Florida |
| Authorized Official Name and Position | Brian A Zalis (PRESIDENT) |
| Authorized Official Contact | 3058216600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miami Lakes Medical Center Associates, P.a. 7150 W 20th Ave Suite 315 Hialeah FL 33016-5529 Ph: (305) 821-6600 | Miami Lakes Medical Center Associates, P.a. 7150 W 20th Ave Suite 315 Hialeah FL 33016-5529 Ph: (305) 821-6600 |
| NPI Number | 1679758817 |
|---|---|
| Provider Enumeration Date | 01/07/2008 |
| Last Update Date | 03/10/2010 |
| Medicare PECOS PAC ID | 2365436466 |
|---|---|
| Medicare Enrollment ID | O20040412001444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679758817 | NPI | - | NPPES |
| 000901 | Other | FL | NHP KOBY |
| 039823300 | Medicaid | FL | |
| 170130 | Other | FL | HUMANA |
| 02704 | Other | FL | MCR KOBY |
| 4337911 | Other | FL | AETNA KOBY |
| 001729 | Other | FL | NHP ZALIS |
| 4521008 | Other | FL | AETNA ZALIS |
| 6972300 | Other | FL | JMH ZALIS |
| 7900000 | Other | FL | JMH KOBY |
| 79162 | Other | FL | MCR ZALIS |
| 014686 | Other | FL | AVMED KOBY |
| 02704 | Other | FL | BCBS KOBY |
| 044892300 | Medicaid | FL | |
| 265997 | Other | FL | AVMED ZALIS |
| 79162 | Other | FL | BCBS ZALIS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME31692 (Florida) | Primary |
| Provider Name | Richard A Koby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740267012 PECOS PAC ID: 8325032428 Enrollment ID: I20070616000005 |
| Provider Name | Brian A Zalis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174500441 PECOS PAC ID: 3779577887 Enrollment ID: I20070616000008 |
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