Provider Demographics
NPI:1467641472
Name:CR MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CR MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:BARBARO
Authorized Official - Last Name:PADRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-259-5570
Mailing Address - Street 1:15439 SW 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1279
Mailing Address - Country:US
Mailing Address - Phone:305-259-5570
Mailing Address - Fax:305-259-5533
Practice Address - Street 1:15439 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1279
Practice Address - Country:US
Practice Address - Phone:305-259-5570
Practice Address - Fax:305-259-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066446174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264395200Medicaid
FL25616BMedicare Oscar/Certification
FL264395200Medicaid
FLF89106Medicare UPIN