Provider Demographics
NPI:1073614186
Name:PEDRO CONDE, M.D., P.A.
Entity Type:Organization
Organization Name:PEDRO CONDE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SOLE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:C
Authorized Official - Last Name:CONDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-275-6346
Mailing Address - Street 1:16807 NW 83RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3453
Mailing Address - Country:US
Mailing Address - Phone:305-275-6346
Mailing Address - Fax:305-275-6347
Practice Address - Street 1:7500 SW 8TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4400
Practice Address - Country:US
Practice Address - Phone:305-275-6346
Practice Address - Fax:305-275-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX I.D. NUMBER