Provider Demographics
NPI:1790160265
Name:DAHDAH MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:DAHDAH MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHDAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-427-3918
Mailing Address - Street 1:7993 NW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2533
Mailing Address - Country:US
Mailing Address - Phone:786-427-3918
Mailing Address - Fax:
Practice Address - Street 1:11760 BIRD RD
Practice Address - Street 2:SUITE 622A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:786-427-3918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty