Provider Demographics
NPI:1053661652
Name:DAGMAR LEMUS MD PA
Entity Type:Organization
Organization Name:DAGMAR LEMUS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAGMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-661-4250
Mailing Address - Street 1:PO BOX 941852
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-1852
Mailing Address - Country:US
Mailing Address - Phone:305-661-4250
Mailing Address - Fax:305-667-2115
Practice Address - Street 1:4685 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2108
Practice Address - Country:US
Practice Address - Phone:305-661-4250
Practice Address - Fax:305-667-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty