Provider Demographics
NPI:1568255818
Name:EXECUTIVE MEDICAL GROUP LLC
Entity type:Organization
Organization Name:EXECUTIVE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-850-7293
Mailing Address - Street 1:39 NW 166TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6049
Mailing Address - Country:US
Mailing Address - Phone:786-850-7292
Mailing Address - Fax:305-675-8479
Practice Address - Street 1:39 NW 166TH ST STE 5
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6049
Practice Address - Country:US
Practice Address - Phone:786-850-7292
Practice Address - Fax:305-675-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center