Provider Demographics
NPI:1033250550
Name:INNOVATIVE MEDICAL HEALTH CENTER CORP
Entity Type:Organization
Organization Name:INNOVATIVE MEDICAL HEALTH CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALPHONSE
Authorized Official - Middle Name:GILOUX
Authorized Official - Last Name:DUFRENY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-756-5160
Mailing Address - Street 1:8051 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-4403
Mailing Address - Country:US
Mailing Address - Phone:305-756-5160
Mailing Address - Fax:305-756-8231
Practice Address - Street 1:8051 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-4403
Practice Address - Country:US
Practice Address - Phone:305-756-5160
Practice Address - Fax:305-756-8231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85072261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care