Provider Demographics
NPI:1528090305
Name:TAMAYO CHELALA AND MILLER PA
Entity type:Organization
Organization Name:TAMAYO CHELALA AND MILLER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMAYO CHELALA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-674-6797
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 490
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-674-6797
Mailing Address - Fax:305-674-0784
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 490
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-674-6797
Practice Address - Fax:305-674-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34513OtherBLUE CROSS BLUE SHIELD
FL268874300Medicaid
FL34513OtherBLUE CROSS BLUE SHIELD