Organization
MIVIP MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISAAC VERBUKH MD (OWBER)
(561) 392-3341
Entity
Organization
Contact information
Practice address
351 NW 42ND AVE, SUITE 408, MIAMI, FL 33126-5683
(561) 392-3341
Mailing address
398 CAMINO GARDENS BLVD, SUITE 102, BOCA RATON, FL 33432-5827
(561) 392-3341
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004L9
BCBSFL
FL
Enumeration date
04/09/2013
Last updated
01/13/2015
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