Provider Demographics
NPI:1447545702
Name:MAYRE URDANETA MD PA
Entity type:Organization
Organization Name:MAYRE URDANETA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYRE
Authorized Official - Middle Name:
Authorized Official - Last Name:URDANETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-826-0606
Mailing Address - Street 1:8060 NORTH WEST 155 STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-826-0606
Mailing Address - Fax:305-826-0630
Practice Address - Street 1:8060 NORTH WEST 155 STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-826-0606
Practice Address - Fax:305-826-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG58621Medicare UPIN