Basic Information
| Provider Information | |||||||||
| NPI: | 1972866572 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED MEDICAL GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1390 NW. 7 - STREET | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052700606 | ||||||||
| FaxNumber: | 3055548288 | ||||||||
| Practice Location | |||||||||
| Address1: | 1390 NW. 7 - STREET | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052700606 | ||||||||
| FaxNumber: | 3055548288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2012 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | FELIX | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3052700606 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.