Provider Demographics
NPI:1932150919
Name:RODOLFO DUMENIGO MD PA
Entity Type:Organization
Organization Name:RODOLFO DUMENIGO MD PA
Other - Org Name:MIAMI BEACH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-534-0076
Mailing Address - Street 1:1400 NW 107TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2746
Mailing Address - Country:US
Mailing Address - Phone:305-534-0076
Mailing Address - Fax:
Practice Address - Street 1:1200 ALTON RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3810
Practice Address - Country:US
Practice Address - Phone:305-534-0076
Practice Address - Fax:305-531-8075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RC0000X, 208D00000X, 363A00000X, 208D00000X, 207RC0000X
FLME58111207RC0000X
FLPA9106247363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEQ458ZOtherMEDICARE PTAN
FLK2249OtherGROUP RDMDPA PTAN
FLGK944ZOtherMEDICARE PTAN
FL09309BOtherMEDICARE PTAN
FLEB648ZOtherMEDICARE PTAN
FL11761ROtherMEDICARE PTAN
FLEQ458ZOtherMEDICARE PTAN
FL004553200Medicaid
FLEB648ZOtherMEDICARE PTAN
FL039780600Medicaid
FLK2249OtherGROUP RDMDPA PTAN