Provider Demographics
NPI:1467117150
Name:OPTIMUM MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:OPTIMUM MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:UYI
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:AIDEYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-209-7069
Mailing Address - Street 1:6900 NW 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3239
Mailing Address - Country:US
Mailing Address - Phone:786-323-7069
Mailing Address - Fax:
Practice Address - Street 1:790 NW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3130
Practice Address - Country:US
Practice Address - Phone:786-323-7069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty