Provider Demographics
NPI:1447292867
Name:MANUEL VIAMONTE, MDPA
Entity type:Organization
Organization Name:MANUEL VIAMONTE, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VIAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-281-9259
Mailing Address - Street 1:9195 SW 72ND ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3488
Mailing Address - Country:US
Mailing Address - Phone:305-271-0300
Mailing Address - Fax:305-661-1455
Practice Address - Street 1:9195 SW 72ND ST
Practice Address - Street 2:SUITE 230
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3488
Practice Address - Country:US
Practice Address - Phone:305-271-0300
Practice Address - Fax:305-661-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME550402086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME55040OtherMEDICAL LICENSE#
FL039184100Medicaid
FL039184100Medicaid
FL09180VMedicare ID - Type UnspecifiedMCARE INDIVIDUAL PROV#
FL039184100Medicaid
FLE75831Medicare UPIN