Provider Demographics
NPI:1053759423
Name:DADE MEDICAL GROUP INC
Entity type:Organization
Organization Name:DADE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:VITAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-360-6657
Mailing Address - Street 1:782 NW 42ND AVE
Mailing Address - Street 2:SUITE 439
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:782 NW 42ND AVE
Practice Address - Street 2:SUITE 439
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5541
Practice Address - Country:US
Practice Address - Phone:786-360-6657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7577261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center