Provider Demographics
NPI:1215475025
Name:MIAMI STROKE, LLC
Entity type:Organization
Organization Name:MIAMI STROKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-235-9550
Mailing Address - Street 1:13550 SW 120TH ST STE 502
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7505
Mailing Address - Country:US
Mailing Address - Phone:305-235-9550
Mailing Address - Fax:305-235-0556
Practice Address - Street 1:11750 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3530
Practice Address - Country:US
Practice Address - Phone:305-235-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23588ROtherP-TAN
FL374074900Medicaid
FL235884Medicare PIN
FL374074900Medicaid