Provider Demographics
NPI:1598171266
Name:KEYSTONE MEDICAL INC
Entity Type:Organization
Organization Name:KEYSTONE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DORTONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-323-0354
Mailing Address - Street 1:13499 BISCAYNE BLVD
Mailing Address - Street 2:SUITE M6-M7
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2043
Mailing Address - Country:US
Mailing Address - Phone:305-956-2728
Mailing Address - Fax:305-940-6201
Practice Address - Street 1:13499 BISCAYNE BLVD
Practice Address - Street 2:SUITE M6-M7
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2043
Practice Address - Country:US
Practice Address - Phone:305-956-2728
Practice Address - Fax:305-940-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77120261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009090200Medicaid
FLG87718Medicare UPIN