Mgm Ipa Dade 001 LLC

NPI #1619303112 in Cutler Bay, Florida

Provider Information

NPI Number
1619303112
Entity Type
Organization
Organization Name
Mgm Ipa Dade 001 LLC
Primary Specialty
Internal Medicine
Enumeration Date
Sep 17, 2013
Last Updated
Sep 17, 2013

Practice Location

Address
8318 SW 193RD ST
State
Florida
ZIP Code
33157-8085
Phone
(305) 964-5119

Authorized Official

Name
MR. MARIO ARMANDO ESPINO JR.
Title
CEO/PRESIDENT
Phone
(786) 395-1165

Specialties & Taxonomy Codes

Specialty
General Practice
Exclusive Provider Organization
Internal Medicine

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