Provider Demographics
NPI:1861701443
Name:SALOMON MITRANI-SEVY MD PA
Entity type:Organization
Organization Name:SALOMON MITRANI-SEVY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SALOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:MITRANI-SEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-551-6666
Mailing Address - Street 1:9829 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3993
Mailing Address - Country:US
Mailing Address - Phone:305-551-6666
Mailing Address - Fax:305-551-1900
Practice Address - Street 1:9829 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3993
Practice Address - Country:US
Practice Address - Phone:305-551-6666
Practice Address - Fax:305-551-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066969208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376686100Medicaid
FL26163Medicare PIN