Provider Demographics
NPI:1295053460
Name:PROFESSIONAL MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:PROFESSIONAL MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZENOBIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRO-BERKELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-962-4680
Mailing Address - Street 1:2301 N UNIVERSITY DR
Mailing Address - Street 2:SUITE# 205
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3617
Mailing Address - Country:US
Mailing Address - Phone:954-962-4680
Mailing Address - Fax:954-966-6927
Practice Address - Street 1:2301 N UNIVERSITY DR
Practice Address - Street 2:SUITE# 205
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3617
Practice Address - Country:US
Practice Address - Phone:954-962-4680
Practice Address - Fax:954-966-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98247207RP1001X
FLME81885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty