Organization
EXELSIOR MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER TIRADO PA-C (PRESIDENT)
(305) 944-1122
Entity
Organization
Contact information
Practice address
951 NE 167TH ST, SUITE 102, NORTH MIAMI BEACH, FL 33162-3711
(305) 944-1122
(305) 944-1133
Mailing address
951 NE 167TH ST, SUITE 102, NORTH MIAMI BEACH, FL 33162-3711
(305) 944-1122
(305) 944-1133
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
PA9107461
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010736200
—
FL
01
—
PA9107461
PA-C
FL
Enumeration date
10/14/2014
Last updated
10/14/2014
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