Provider Demographics
NPI:1285362731
Name:PRIVATE MEDICAL FLORIDA PA
Entity type:Organization
Organization Name:PRIVATE MEDICAL FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-703-7633
Mailing Address - Street 1:3580 CALIFORNIA ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1716
Mailing Address - Country:US
Mailing Address - Phone:415-830-3090
Mailing Address - Fax:
Practice Address - Street 1:1111 LINCOLN RD STE 301&375
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2452
Practice Address - Country:US
Practice Address - Phone:305-703-7633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty