Basic Information
| Provider Information | |||||||||
| NPI: | 1477520500 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TODD C ALEA M D P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 430738 | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 332430738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862432950 | ||||||||
| FaxNumber: | 7862432951 | ||||||||
| Practice Location | |||||||||
| Address1: | 2804 NE 8TH ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330335613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862432950 | ||||||||
| FaxNumber: | 7832432951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 08/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | ALEA | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7862432950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | ME86935 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 78690 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 272212700 | 05 | FL | MEDICAID |