MEDICARE: RODOLFO DUMENIGO MD PA

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
2	207R00000X	Internal Medicine Physician	ME83960	FL
3	207R00000X	Internal Medicine Physician
4	207RC0000X	Cardiovascular Disease Physician	ME58111	FL
5	207RC0000X	Cardiovascular Disease Physician
6	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1568831311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RODOLFO DUMENIGO MD PA

Provider Business Mailing Address
First Line	:	1400 NW 107TH AVE STE 500
Second Line	:
City	:	SWEETWATER
State	:	FL
Zip	:	33172-2746
Country	:	US
Telephone Number	:	305-534-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	551 E 49TH ST
Second Line	:	SUITE 1-8
City	:	HIALEAH
State	:	FL
Zip	:	33013-1904
Country	:	US
Telephone Number	:	305-534-0076
Fax Number	:	305-735-6472

Authorized Official
Title or Position	:	CMO
Name	:	JOSE D SUAREZ
Credential	:
Telephone Number	:	305-534-0076

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	10/30/2023

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