Provider Demographics
NPI:1497441935
Name:KOREME ANTI-AGING & MEDICAL GROUP
Entity Type:Organization
Organization Name:KOREME ANTI-AGING & MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-953-6567
Mailing Address - Street 1:6917 COLLINS AVE APT 426
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-7205
Mailing Address - Country:US
Mailing Address - Phone:305-992-4181
Mailing Address - Fax:
Practice Address - Street 1:6917 COLLINS AVE APT 426
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-7205
Practice Address - Country:US
Practice Address - Phone:305-992-4181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service