Provider Demographics
NPI:1407004427
Name:MIAMI HAND, PLASTIC & RECONSTRUCTIVE CENTER LLC
Entity type:Organization
Organization Name:MIAMI HAND, PLASTIC & RECONSTRUCTIVE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-426-3779
Mailing Address - Street 1:2750 S DOUGLAS RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2764
Mailing Address - Country:US
Mailing Address - Phone:305-426-3779
Mailing Address - Fax:305-925-8100
Practice Address - Street 1:2750 S DOUGLAS RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-2764
Practice Address - Country:US
Practice Address - Phone:305-426-3779
Practice Address - Fax:305-925-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty