Provider Demographics
NPI:1215272026
Name:FMD MEDICAL CORPORATION
Entity type:Organization
Organization Name:FMD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-854-2899
Mailing Address - Street 1:3659 S MIAMI AVE STE 5005
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4221
Mailing Address - Country:US
Mailing Address - Phone:305-854-2899
Mailing Address - Fax:305-859-9677
Practice Address - Street 1:3659 S MIAMI AVE STE 5005
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4221
Practice Address - Country:US
Practice Address - Phone:305-854-2899
Practice Address - Fax:305-859-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88547174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty