Provider Demographics
NPI:1659592319
Name:INTERNAL MEDICINE ASSOCIATES OF SOUTH FLORIDA, P.A.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF SOUTH FLORIDA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-940-6973
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4708
Mailing Address - Country:US
Mailing Address - Phone:305-940-6973
Mailing Address - Fax:305-949-6973
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 100
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4708
Practice Address - Country:US
Practice Address - Phone:305-940-6973
Practice Address - Fax:305-949-6973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS000438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254769400Medicaid
FL254769400Medicaid
FL40854Medicare ID - Type Unspecified