Provider Demographics
NPI:1992150718
Name:WMC HEALTH GROUP OF KISSIMMEE
Entity type:Organization
Organization Name:WMC HEALTH GROUP OF KISSIMMEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEDRAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-692-9009
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4707
Mailing Address - Country:US
Mailing Address - Phone:305-692-9009
Mailing Address - Fax:305-501-4220
Practice Address - Street 1:3208 N JOHN YOUNG PKWY
Practice Address - Street 2:H27
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7549
Practice Address - Country:US
Practice Address - Phone:305-692-9009
Practice Address - Fax:305-501-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66407207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty