MEDICARE: CDR HEALTH CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1497352587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDR HEALTH CARE INC

Provider Business Mailing Address
First Line	:	11740 SW 80TH ST STE 102
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4822
Country	:	US
Telephone Number	:	786-235-8534
Fax Number	:	786-235-8501

Provider Business Practice Location Address
First Line	:	313 NORTON DR STE 102
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5965
Country	:	US
Telephone Number	:	850-738-7977
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. TINA VIDAL-DUART
Credential	:	N/A
Telephone Number	:	786-235-8534

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	04/04/2024

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