# SUPRA MEDICAL GROUP II, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SUPRA MEDICAL GROUP II, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1205592656
- **Legal business name:** SUPRA MEDICAL GROUP II, LLC
- **Authorized official:** KLEYDSON DA SILVA (CEO)
- **Authorized official phone:** (305) 200-5210

## Contact information

- **Practice address:** 10300 SW 72ND ST STE 387, MIAMI, FL 33173-3020
- **Practice address phone:** (305) 200-5210
- **Practice address fax:** (305) 200-5780
- **Mailing address:** 10300 SW 72ND ST STE 387, MIAMI, FL 33173-3020
- **Mailing address phone:** (305) 200-5210
- **Mailing address fax:** (305) 200-5780

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |
| 251S00000X | Community/Behavioral Health Agency | — | — | — |

## Other

- **Enumeration date:** 11/10/2021
- **Last updated:** 11/10/2021