Provider Demographics
NPI:1124551320
Name:INTERCARIBBEAN MEDICAL GROUP INC
Entity Type:Organization
Organization Name:INTERCARIBBEAN MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:HANABERGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-609-8316
Mailing Address - Street 1:3850 SW 87TH AVE
Mailing Address - Street 2:STE 305A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5400
Mailing Address - Country:US
Mailing Address - Phone:786-609-8316
Mailing Address - Fax:305-468-6367
Practice Address - Street 1:3850 SW 87TH AVE
Practice Address - Street 2:STE 305A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5400
Practice Address - Country:US
Practice Address - Phone:786-609-8316
Practice Address - Fax:305-468-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty