1811946312 NPI number — TAMIAMI MEDICAL GROUP, INC.

Table of content: GENE DENNEHY LPCC, LADAC (NPI 1700233517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811946312 NPI number — TAMIAMI MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMIAMI MEDICAL GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811946312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 NW 72ND AVE
Provider Second Line Business Mailing Address:
SUITE # 577
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-1936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-599-1545
Provider Business Mailing Address Fax Number:
305-599-9928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 NW 72ND AVE
Provider Second Line Business Practice Location Address:
SUITE # 577
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-599-1545
Provider Business Practice Location Address Fax Number:
305-599-9928
Provider Enumeration Date:
05/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUERRA
Authorized Official First Name:
OMAR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-599-1545

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , with the licence number:  NA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)