Provider Demographics
NPI:1770569956
Name:SOUTH DADE MEDICAL GROUP LLP
Entity type:Organization
Organization Name:SOUTH DADE MEDICAL GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABELARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-573-1770
Mailing Address - Street 1:PO BOX 901430
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33090-1430
Mailing Address - Country:US
Mailing Address - Phone:786-573-1770
Mailing Address - Fax:786-573-1501
Practice Address - Street 1:975 BAPTIST WAY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033
Practice Address - Country:US
Practice Address - Phone:786-573-1770
Practice Address - Fax:786-573-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5778Medicare PIN