Provider Demographics
NPI:1487611844
Name:NEW LIFE MEDICAL INSTITUTE INC
Entity type:Organization
Organization Name:NEW LIFE MEDICAL INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAILOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-857-9800
Mailing Address - Street 1:861 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3703
Mailing Address - Country:US
Mailing Address - Phone:305-857-9800
Mailing Address - Fax:305-857-9802
Practice Address - Street 1:861 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3703
Practice Address - Country:US
Practice Address - Phone:305-857-9800
Practice Address - Fax:305-857-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51394207QG0300X, 207QG0300X
FLME28831207Q00000X
208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278171900Medicaid
FL33228Medicare ID - Type UnspecifiedGROUP PRACTICE