Unknown Individual – General Practice Physician, NPI 1720072598
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2011-10-20. Reason: Felony conviction relating to controlled substance (mandatory; min. 5 years).
General Practice Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
345, Ocean Drive, South Beach, Miami Beach, Miami-Dade County, Florida, 33139, United States
APT. 926
MIAMI BEACH, FL 331398756
Phone: (305) 673-6050
Type: Mailing
2140, West Flagler Street, Little Havana, Latin Quarter, Miami, Miami-Dade County, Florida, 33135, United States
SUITE 205
MIAMI, FL 331355600
Phone: (305) 649-1599
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33139)
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