MEDICARE: D. R. TESTING , 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	:	1518696228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D. R. TESTING , INC.

Provider Business Mailing Address
First Line	:	300 W SUNRISE BLVD
Second Line	:	SUITE 9A
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-6263
Country	:	US
Telephone Number	:	954-440-4776
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 W SUNRISE BLVD
Second Line	:	SUITE 9A
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-6263
Country	:	US
Telephone Number	:	954-440-4776
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. KIMBERLY GRANT MANSELL
Credential	:	DO
Telephone Number	:	954-702-4844

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/08/2022

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