Provider Demographics
NPI:1508995747
Name:SOUTHDADE HEALTH SERVICES
Entity Type:Organization
Organization Name:SOUTHDADE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULES
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:MINKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-255-3950
Mailing Address - Street 1:9765 SW 184TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6932
Mailing Address - Country:US
Mailing Address - Phone:305-255-3950
Mailing Address - Fax:
Practice Address - Street 1:9765 SW 184TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6932
Practice Address - Country:US
Practice Address - Phone:305-255-3950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS1516261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7196Medicare ID - Type Unspecified
FLD49760Medicare UPIN