Provider Demographics
NPI:1649329020
Name:MIAMI DADE MEDICAL GROUP
Entity type:Organization
Organization Name:MIAMI DADE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITH-CHE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:786-888-1111
Mailing Address - Street 1:4692 NW 183RD ST
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3054
Mailing Address - Country:US
Mailing Address - Phone:786-888-1111
Mailing Address - Fax:305-830-2456
Practice Address - Street 1:4692 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33055-3054
Practice Address - Country:US
Practice Address - Phone:786-888-1111
Practice Address - Fax:305-830-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7044174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty