Basic Information
| Provider Information | |||||||||
| NPI: | 1467005116 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIAMI MENS HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2263 SW 37TH AVE APT 441 | ||||||||
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| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331453262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162086781 | ||||||||
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| Practice Location | |||||||||
| Address1: | 135 SAN LORENZO AVE STE 540 | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331461880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054442290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2019 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | BRENNAN | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7162086781 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.