Provider Demographics
NPI:1598943169
Name:HUMBERTO C MACHADO JR MD PA
Entity type:Organization
Organization Name:HUMBERTO C MACHADO JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-529-9901
Mailing Address - Street 1:747 PONCE DE LEON BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2073
Mailing Address - Country:US
Mailing Address - Phone:305-529-9901
Mailing Address - Fax:305-569-3011
Practice Address - Street 1:747 PONCE DE LEON BLVD STE 503
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2073
Practice Address - Country:US
Practice Address - Phone:305-529-9901
Practice Address - Fax:305-569-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77677207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003423800Medicaid
FLK5851Medicare PIN