Healthcare Provider Details

I. General information

NPI: 1083617195
Provider Name (Legal Business Name): DYABETIMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9045 LA FONTANA BLVD STE C7A
BOCA RATON FL
33434-5637
US

IV. Provider business mailing address

9045 LA FONTANA BLVD STE C7A
BOCA RATON FL
33434-5637
US

V. Phone/Fax

Practice location:
  • Phone: 866-807-0024
  • Fax: 866-807-0031
Mailing address:
  • Phone: 866-807-0024
  • Fax: 866-807-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. GREGG A KIKEN
Title or Position: PRESIDENT
Credential:
Phone: 866-807-0024