Organization
NEUROLOGY CONSULTANTS OF SOUTH FLORIDA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTHA BUSTAMANTE M.D. (PRESIDENT)
(305) 826-5655
Entity
Organization
Contact information
Practice address
4160 W 16TH AVE, SUITE 100, HIALEAH, FL 33012-5853
(305) 826-5655
(305) 826-5598
Mailing address
PO BOX 126629, HIALEAH, FL 33012-1610
(305) 826-5655
(305) 826-5598
Taxonomy
Speciality
Code
Description
License number
State
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
ME58534
FL
2084N0400X
Neurology Physician
ME58534
FL
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
ME58534
FL
2084P0005X
Neurodevelopmental Disabilities Physician
ME58534
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
99443
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
12/08/2006
Last updated
07/19/2010
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