Provider Demographics
NPI:1902259724
Name:BELDOR GROUP LLC
Entity Type:Organization
Organization Name:BELDOR GROUP LLC
Other - Org Name:MIB SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-642-0810
Mailing Address - Street 1:730 NE 191ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3922
Mailing Address - Country:US
Mailing Address - Phone:786-916-3621
Mailing Address - Fax:786-916-3621
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7808
Practice Address - Country:US
Practice Address - Phone:888-362-9902
Practice Address - Fax:800-518-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-16
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123276208600000X
NY60.284987-1208600000X
OH35.097759208600000X
FLME123342208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLII471XMedicare UPIN
FLII471ZMedicare UPIN
FLII471YMedicare UPIN