Provider Demographics
NPI:1578508446
Name:KRAUTHAMER & SIMON MDS PA
Entity Type:Organization
Organization Name:KRAUTHAMER & SIMON MDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUTHAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-662-8117
Mailing Address - Street 1:6200 SW 73RD ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4679
Mailing Address - Country:US
Mailing Address - Phone:786-662-8117
Mailing Address - Fax:786-662-5365
Practice Address - Street 1:6200 SW 73RD ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4679
Practice Address - Country:US
Practice Address - Phone:786-662-8117
Practice Address - Fax:786-662-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99004OtherBCBS OF FLORIDA
FL99004Medicare ID - Type UnspecifiedMEDICARE