Provider Demographics
NPI:1144633256
Name:GENERAL HEALTH MEDICAL GROUP,INC
Entity type:Organization
Organization Name:GENERAL HEALTH MEDICAL GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-409-3957
Mailing Address - Street 1:85 GRAND CANAL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2566
Mailing Address - Country:US
Mailing Address - Phone:786-409-3957
Mailing Address - Fax:
Practice Address - Street 1:85 GRAND CANAL DR STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2566
Practice Address - Country:US
Practice Address - Phone:786-409-3957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110036261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty