Healthcare Provider Details

I. General information

NPI: 1053661652
Provider Name (Legal Business Name): DAGMAR LEMUS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4685 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2108
US

IV. Provider business mailing address

PO BOX 941852
MIAMI FL
33194-1852
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-4250
  • Fax: 305-667-2115
Mailing address:
  • Phone: 305-661-4250
  • Fax: 305-667-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAGMAR LEMUS
Title or Position: OWNER
Credential: MD
Phone: 305-661-4250