Provider Demographics
NPI:1972582328
Name:KENDALL NUCLEAR MEDICINE INC
Entity Type:Organization
Organization Name:KENDALL NUCLEAR MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-596-7735
Mailing Address - Street 1:9000 SW 87TH COURT
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176
Mailing Address - Country:US
Mailing Address - Phone:305-596-7735
Mailing Address - Fax:305-596-3460
Practice Address - Street 1:9000 SW 87TH COURT
Practice Address - Street 2:SUITE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-596-7735
Practice Address - Fax:305-596-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10321207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4379Medicare ID - Type Unspecified