Provider Demographics
NPI:1033436555
Name:KENDALL URGENT CARE CORP
Entity Type:Organization
Organization Name:KENDALL URGENT CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:L
Authorized Official - Last Name:IZQUIERDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-228-6400
Mailing Address - Street 1:8356 SW 40 STREET SUITE L
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:305-228-6400
Mailing Address - Fax:305-228-6500
Practice Address - Street 1:9995 SW 72ND ST STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4662
Practice Address - Country:US
Practice Address - Phone:305-603-7800
Practice Address - Fax:305-603-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL95729207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95729OtherME