Provider Demographics
NPI:1215177951
Name:BARDISA MEDICAL CENTER
Entity Type:Organization
Organization Name:BARDISA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSELIND
Authorized Official - Middle Name:
Authorized Official - Last Name:BARDISA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-661-2002
Mailing Address - Street 1:7374 SW 93RD AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5201
Mailing Address - Country:US
Mailing Address - Phone:305-661-2002
Mailing Address - Fax:305-661-2003
Practice Address - Street 1:7374 SW 93RD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5201
Practice Address - Country:US
Practice Address - Phone:305-661-2002
Practice Address - Fax:305-661-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 8030207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H63833Medicare UPIN