DR. KELLY J MEDWID (NPI# 1639305212) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639305212 |
| Entity Type | Individual |
| Full Name | DR. KELLY J MEDWID |
| Credential | MD |
| Practice Address |
11750 Sw 40th Street Miami FL 33175-3530 |
| Mailing Address |
1613 N. Harrison Parkway Suite 200, Mailstop Sh-9a Sunrise FL 33323-2896 |
| Practice Telephone | 3059210961 |
| Mailing Telephone | 9548382955 |
| Mailing Fax Number | 9546163866 |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2015-07-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | ME123466 | FL | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
11750 SW 40TH STREET |
| City | MIAMI |
| State | FL |
| Zip Code | 33175-3530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154374460 | Karen M. Clasby | Physician Assistant | 11750 Sw 40th Street, Miami, FL 33175 | 2006-05-18 |
| 1255999470 | Jose Daniel Cordoba Morales | Student in an Organized Health Care Education/Training Program | 11750 Sw 40th Street, Miami, FL 33175-3530 | 2019-06-03 |
| 1720362999 | Samuel B Knight | Registered Nurse | 11750 Sw 40th Street, Miami, FL 33175 | 2011-10-05 |
| 1700178423 | Carole Avril Douriez | Emergency Medicine | 11750 Sw 40th Street, Kendall Regional Medical Center, Miami, FL 33175 | 2011-05-12 |
| 1790077634 | Anish H.s. Dhadwal | Emergency Medicine | 11750 Sw 40th Street, Miami, FL 33175 | 2011-05-11 |
| 1699065904 | Carlos Rodriguez | Anesthesiology | 11750 Sw 40th Street, Miami, FL 33175 | 2011-04-08 |
| 1003130220 | Ilene Ramirez | Nurse Anesthetist, Certified Registered | 11750 Sw 40th Street, Miami, FL 33175-3530 | 2010-03-17 |
| 1205161858 | Melissa Figueroa Massanet | Emergency Medicine | 11750 Sw 40th Street, Miami, FL 33175 | 2009-10-14 |
| 1487896353 | Maria Del Carmen Forrest | Anesthesiology | 11750 Sw 40th Street, Miami, FL 33175 | 2009-03-24 |
| 1417046277 | Linda Allen | Radiology | 11750 Sw 40th Street, Miami, FL 33175 | 2006-10-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548885965 | Kevin Bernardo Gonzalez | Behavior Technician | 11895 Sw 37 St, Miami, FL 33175 | 2020-06-11 |
| 1619509106 | Gladysbel Lorenzo | Nurse Practitioner | 11740 Sw 42st, Miami, FL 33175 | 2020-02-12 |
| 1154885200 | Vanessa Arzola Dmd Pa and Associates | Clinic/Center | 13419 Sw 56th Street, Miami, Miami, FL 33175 | 2019-01-23 |
| 1588145932 | Mailen Gonzalez | Nurse Practitioner | 12294 Sw 29 Ter, Miami, FL 33175 | 2018-08-23 |
| 1639655350 | Carolina Marie Trueba | Behavior Technician | 12825 Sw 49th Terr, Miami, FL 33175 | 2018-07-16 |
| 1033611504 | Joan Coro | Behavior Technician | 12905 Sw 42nd St Suite 219, Miami, FL 33175 | 2018-03-01 |
| 1417456864 | Ignacio Alzugaray | Nurse Practitioner | 12317 Sw 20th Ter, Miami, FL 33175 | 2018-02-12 |
| 1215436993 | Desiree Rengifo-glasgow | Nurse Practitioner | 11865 Sw 26th St Ste J2, Miami, FL 33175 | 2018-02-07 |
| 1639678691 | Behavior Professional Consultants Corp. | Community/Behavioral Health | 2460 Sw 137th Ave 242, Miami, FL 33175 | 2018-02-06 |
| 1992204291 | Humberto Lorenzo Paez | Nurse Practitioner | 4205 Sw 136th Place, Miami, FL 33175 | 2018-02-02 |
| Find all providers in zip 33175 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487018461 | Rachel Libby | Emergency Medicine | 2965 Coconut Ave, Miami, FL 33133-3761 | 2016-04-06 |
| 1851775464 | Matthew Brooks | Emergency Medicine | 601 Ne 36th St Apt 1311, Miami, FL 33137-3951 | 2015-07-13 |
| 1861838823 | Carlos A Penaherrera | Emergency Medicine | 145 Sw 13th St, Apt 626, Miami, FL 33130-4226 | 2013-05-17 |
| 1831532480 | Steven Neil Ecker | Emergency Medicine | 10002 Sw 57th Ct, Miami, FL 33156-2000 | 2013-04-14 |
| 1851657019 | Roderick D Cousins | Emergency Medicine | 11750 Sw 40th St., Miami, FL 33175 | 2012-04-02 |
| 1508137563 | Jeffrey Bettinger | Emergency Medicine | 2000 S Bayshore Dr, Villa 45, Miami, FL 33133-3256 | 2012-01-23 |
| 1164728929 | Claire Holekamp | Emergency Medicine | 300 S Biscayne Blvd Apt 3408, Miami, FL 33131-5379 | 2011-01-26 |
| 1710290572 | Modinat Balogun | Emergency Medicine | 2020 N Bayshore Dr Apt 2205, Miami, FL 33137 | 2010-07-22 |
| 1790003051 | Suzanne Nicole Bialeck | Emergency Medicine | 13837 Sw 109th Ln, Miami, FL 33186-3269 | 2010-05-12 |
| 1427288109 | Kristine Mascarinas | Emergency Medicine | 14150 Sw 136th St, Miami, FL 33186-5506 | 2009-07-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.