Provider Demographics
NPI:1700867488
Name:DIGESTIVE MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:DIGESTIVE MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:MADERAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-822-4108
Mailing Address - Street 1:2140 W 68TH ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1815
Mailing Address - Country:US
Mailing Address - Phone:305-822-4108
Mailing Address - Fax:786-497-2989
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-822-4108
Practice Address - Fax:305-822-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39853OtherBCBS #
FL372736000Medicaid
FL39853Medicare PIN