Provider Demographics
NPI:1285747063
Name:MIDTOWN MEDICAL GROUP INC
Entity type:Organization
Organization Name:MIDTOWN MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-573-6881
Mailing Address - Street 1:21 NW 36 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127
Mailing Address - Country:US
Mailing Address - Phone:305-573-6886
Mailing Address - Fax:305-573-6816
Practice Address - Street 1:21 NW 36 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127
Practice Address - Country:US
Practice Address - Phone:305-573-6886
Practice Address - Fax:305-573-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K9099Medicare ID - Type Unspecified