Organization
MEDICAL SUPERIOR GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAFAEL S GRILLO M.D (PRESIDENT)
(305) 563-7914
Entity
Organization
Contact information
Practice address
434 SW 12TH AVE, STE 102, MIAMI, FL 33130-2440
(305) 563-7914
Mailing address
434 SW 12TH AVE, STE 102, MIAMI, FL 33130-2440
(305) 563-7914
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
ME66588
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
375697100
—
FL
Enumeration date
06/23/2015
Last updated
06/23/2015
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