Provider Demographics
NPI:1619302643
Name:KHARI BRIDGES, MD LLC
Entity Type:Organization
Organization Name:KHARI BRIDGES, MD LLC
Other - Org Name:MIAMI DERMATOLOGY AND COSMETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-670-0146
Mailing Address - Street 1:8950 SW 74TH CT
Mailing Address - Street 2:SUITE 1413
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3171
Mailing Address - Country:US
Mailing Address - Phone:305-670-0146
Mailing Address - Fax:305-670-8943
Practice Address - Street 1:8950 SW 74TH CT
Practice Address - Street 2:SUITE 1413
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3171
Practice Address - Country:US
Practice Address - Phone:305-670-0146
Practice Address - Fax:305-670-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99204207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty