Basic Information
| Provider Information | |||||||||
| NPI: | 1295274983 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIAMI VA HEALTHCARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4631 NW 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333094002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612450900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 NW 16TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331251624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055757000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2017 | ||||||||
| LastUpdateDate: | 02/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | TRANG | ||||||||
| AuthorizedOfficialFirstName: | JIMMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PODIATRY RESIDENCY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3055757000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | PR497 | FL | Y | Hospitals | General Acute Care Hospital | Rural |
No ID Information.