Provider Demographics
NPI:1710092606
Name:MEDICAL DIAGNOSTIC CORP
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUNIESKY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-883-4300
Mailing Address - Street 1:6955 NW 77TH AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2852
Mailing Address - Country:US
Mailing Address - Phone:305-883-4300
Mailing Address - Fax:305-883-9996
Practice Address - Street 1:6955 NW 77TH AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-2852
Practice Address - Country:US
Practice Address - Phone:305-883-4300
Practice Address - Fax:305-883-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7123Medicare ID - Type UnspecifiedPROVIDER NUMER