Basic Information
| Provider Information | |||||||||
| NPI: | 1093086902 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH MIAMI GYN ONCOLOGY PHYSICIANS LLC | ||||||||
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| OtherOrganizationName: | SOUTH MIAMI GYN ONCOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6855 S RED RD STE 540 | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866627111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8900 N KENDALL DR | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331762118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865962000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | ARSENAULT | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7866627111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.