1205208139 NPI number — INNOVATIVE MEDICAL RESEARCH OF SOUTH FLORIDA

Table of content: (NPI 1205208139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205208139 NPI number — INNOVATIVE MEDICAL RESEARCH OF SOUTH FLORIDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE MEDICAL RESEARCH OF SOUTH FLORIDA
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:
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Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1205208139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20880 WEST DIXIE HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
AVENTURA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33180-1115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-757-2226
Provider Business Mailing Address Fax Number:
305-405-0535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20880 WEST DIXIE HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33180-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-757-2226
Provider Business Practice Location Address Fax Number:
305-405-0535
Provider Enumeration Date:
10/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SALTZMAN
Authorized Official First Name:
MARC
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-759-1881

Provider Taxonomy Codes

  • Taxonomy code: 1744R1102X , with the licence number:  ME20954 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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