Basic Information
| Provider Information | |||||||||
| NPI: | 1497709000 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH FLORIDA INTERNAL MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3191 CORAL WAY | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331453213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054616060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 440 W 49TH ST | ||||||||
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| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330123603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058285000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ALARCON | ||||||||
| AuthorizedOfficialFirstName: | EDUARDO | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3054616060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME0044378 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 21697 | 01 | FL | MEDICARE GROUP NUMBER | OTHER |