Healthcare Provider Details

I. General information

NPI: 1679964258
Provider Name (Legal Business Name): LYLE H GUMER DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CORAL WAY SUITE 201
CORAL GABLES FL
33134-4930
US

IV. Provider business mailing address

401 CORAL WAY SUITE 201
CORAL GABLES FL
33134-4930
US

V. Phone/Fax

Practice location:
  • Phone: 305-446-8423
  • Fax: 305-446-0262
Mailing address:
  • Phone: 305-446-8423
  • Fax: 305-446-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. INGRID RADDATZ GUMER
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-446-8423