# M F FERNANDEZ MD KELLY MEDICAL CENTER CO INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245381052
- **Authorized official:** MANUEL F FERNANDEZ MD (OWNER)
- **Authorized official phone:** (305) 245-7787

## Contact information

- **Practice address:** 29613 SW 162ND AVE, HOMESTEAD, FL 33033-3328
- **Practice address phone:** (305) 245-7787
- **Practice address fax:** (305) 245-7740
- **Mailing address:** 29613 SW 162ND AVE, HOMESTEAD, FL 33033-3328
- **Mailing address phone:** (305) 245-7787
- **Mailing address fax:** (305) 245-7740

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | ME66369 | FL | Yes |

## Other

- **Enumeration date:** 01/16/2007
- **Last updated:** 07/01/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 373393901 | — | FL |