Provider Demographics
NPI:1669747424
Name:KENDALL PAIN CENTER LLC
Entity type:Organization
Organization Name:KENDALL PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HASHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SULTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-559-5554
Mailing Address - Street 1:PO BOX 824610
Mailing Address - Street 2:
Mailing Address - City:SOUTH FLORIDA
Mailing Address - State:FL
Mailing Address - Zip Code:33082-4610
Mailing Address - Country:US
Mailing Address - Phone:305-559-5554
Mailing Address - Fax:305-559-5515
Practice Address - Street 1:11760 SW 40TH ST
Practice Address - Street 2:411
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-559-5554
Practice Address - Fax:305-559-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75237174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME75237OtherMEDICAL LIC