NPIMap

Organization Active NPI

Miami Lakes Medical Center Associates PA

  • Family Medicine Physician
  • Hialeah, FL
National Provider Identifier
1174518096
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MIAMI LAKES MEDICAL CENTER ASSOCIATES PA
Practice address
7150 W 20TH Ave
Suite 315
Hialeah, FL 33016-5529
Phone
(305) 821-6600
Fax
(305) 821-0773
NPI assigned
Sep 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard Alan Koby, M.D.
Title
Vice President
Phone
(305) 821-6600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

7150 W 20TH Ave
Suite 315
Hialeah, FL 33016-5529

Mailing address

7150 W 20TH Ave
Suite 315
Hialeah, FL 33016-5529
Phone (305) 821-6600

Other names 1

  • Pembroke Lakes Medical Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Miami Lakes Medical Center Associates PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174518096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7150 W 20TH AVE",
            "address_2": "SUITE 315",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330165529",
            "telephone_number": "305-821-6600",
            "fax_number": "305-821-0773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7150 W 20TH AVE",
            "address_2": "SUITE 315",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330165529",
            "telephone_number": "305-821-6600",
            "fax_number": "305-821-0773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIAMI LAKES MEDICAL CENTER ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOBY",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "305-821-6600",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pembroke Lakes Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hialeah, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.