Provider Demographics
NPI:1649830613
Name:CALEDONIA DERM-PATH LLC
Entity type:Organization
Organization Name:CALEDONIA DERM-PATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-237-7090
Mailing Address - Street 1:3850 HOLLYWOOD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6745
Mailing Address - Country:US
Mailing Address - Phone:954-237-7090
Mailing Address - Fax:
Practice Address - Street 1:7091 SW 47TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4652
Practice Address - Country:US
Practice Address - Phone:786-417-0732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory