Healthcare Provider Details

I. General information

NPI: 1205208139
Provider Name (Legal Business Name): INNOVATIVE MEDICAL RESEARCH OF SOUTH FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20880 WEST DIXIE HIGHWAY SUITE 103
AVENTURA FL
33180-1115
US

IV. Provider business mailing address

20880 WEST DIXIE HIGHWAY SUITE 103
AVENTURA FL
33180-1115
US

V. Phone/Fax

Practice location:
  • Phone: 305-757-2226
  • Fax: 305-405-0535
Mailing address:
  • Phone: 305-757-2226
  • Fax: 305-405-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License NumberME20954
License Number StateFL

VIII. Authorized Official

Name: DR. MARC A SALTZMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 305-759-1881