Organization
ST PETER MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRIAM L RIVERA-IRIZARRY MD (CEO)
(407) 729-8173
Entity
Organization
Contact information
Practice address
339 CYPRESS PKWY STE 110, KISSIMMEE, FL 34759
(407) 922-0240
(407) 343-5199
Mailing address
PO BOX 582170, KISSIMMEE, FL 34758-0027
(407) 922-0240
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356304828
—
FL
Enumeration date
06/23/2018
Last updated
09/16/2024
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