Provider Demographics
NPI:1043242456
Name:KENDALL SOUTH MEDICAL CENTER INC
Entity Type:Organization
Organization Name:KENDALL SOUTH MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ ESCARPANTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-388-1118
Mailing Address - Street 1:14708 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4041
Mailing Address - Country:US
Mailing Address - Phone:305-388-1118
Mailing Address - Fax:305-388-0336
Practice Address - Street 1:14740 SW 26TH ST STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5948
Practice Address - Country:US
Practice Address - Phone:305-388-1118
Practice Address - Fax:305-223-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8250Medicare ID - Type Unspecified