Organization
125ST NM CORP
Active
Other names
125th Street Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
IGOR NIZNIK (OWNER)
(786) 235-7240
Entity
Organization
Contact information
Practice address
505 NE 125TH ST, NORTH MIAMI, FL 33161-4718
(786) 235-7240
(786) 235-7241
Mailing address
505 NE 125TH ST, NORTH MIAMI, FL 33161-4718
(786) 235-7240
(786) 235-7241
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
HCC8934
FL
Other
Enumeration date
07/14/2011
Last updated
07/14/2011
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