Provider Demographics
NPI:1467751982
Name:IVAN DANGER PHD PA
Entity Type:Organization
Organization Name:IVAN DANGER PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DANGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-274-9755
Mailing Address - Street 1:9370 SUNSET DR
Mailing Address - Street 2:SUITE A240
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5431
Mailing Address - Country:US
Mailing Address - Phone:305-274-9755
Mailing Address - Fax:305-274-4137
Practice Address - Street 1:9370 SUNSET DR
Practice Address - Street 2:SUITE A240
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5431
Practice Address - Country:US
Practice Address - Phone:305-274-9755
Practice Address - Fax:305-274-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73812Medicare PIN