Provider Demographics
NPI:1104101666
Name:MIAMI COMPREHENSIVE MEDICINE GROUP PA
Entity type:Organization
Organization Name:MIAMI COMPREHENSIVE MEDICINE GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-851-2870
Mailing Address - Street 1:345 PALERMO AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6607
Mailing Address - Country:US
Mailing Address - Phone:305-851-2870
Mailing Address - Fax:305-851-2871
Practice Address - Street 1:4685 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2108
Practice Address - Country:US
Practice Address - Phone:305-851-2870
Practice Address - Fax:305-851-2871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty