Provider Demographics
NPI:1689838757
Name:DNDM HEALTH AND MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:DNDM HEALTH AND MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GERMAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-348-7353
Mailing Address - Street 1:5941 NW 173RD DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5109
Mailing Address - Country:US
Mailing Address - Phone:305-321-3757
Mailing Address - Fax:305-675-8034
Practice Address - Street 1:5941 NW 173RD DR
Practice Address - Street 2:SUITE 1
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5109
Practice Address - Country:US
Practice Address - Phone:305-321-3757
Practice Address - Fax:305-675-8034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty