Basic Information
| Provider Information | |||||||||
| NPI: | 1629065941 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METROPOLITAN HEALTH NETWORKS LT BLUE ZONE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | METCARE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 S AUSTRALIAN AVE | ||||||||
| Address2: | STE 400 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334015018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618058500 | ||||||||
| FaxNumber: | 5618058501 | ||||||||
| Practice Location | |||||||||
| Address1: | 18300 NE 19TH AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331795000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059497273 | ||||||||
| FaxNumber: | 3059498025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GARTNER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5618058500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.