Provider Demographics
NPI:1174518096
Name:MIAMI LAKES MEDICAL CENTER ASSOCIATES PA
Entity type:Organization
Organization Name:MIAMI LAKES MEDICAL CENTER ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KOBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-821-6600
Mailing Address - Street 1:7150 W 20TH AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5529
Mailing Address - Country:US
Mailing Address - Phone:305-821-6600
Mailing Address - Fax:305-821-0773
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5529
Practice Address - Country:US
Practice Address - Phone:305-821-6600
Practice Address - Fax:305-821-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39053Medicare ID - Type UnspecifiedMIAMI LAKES MEDICAL CTR