Healthcare Provider Details

I. General information

NPI: 1194160416
Provider Name (Legal Business Name): LUIS ANTONIO RAMIREZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7902 NW 36TH ST STE 202
DORAL FL
33166-6637
US

IV. Provider business mailing address

7902 NW 36TH ST STE 202
DORAL FL
33166-6637
US

V. Phone/Fax

Practice location:
  • Phone: 305-593-0024
  • Fax: 866-235-6174
Mailing address:
  • Phone: 305-593-0024
  • Fax: 866-235-6174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME59827
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME59827
License Number StateZZ

VIII. Authorized Official

Name: LUIS A RAMIREZ
Title or Position: PRESIDENT
Credential: MD
Phone: 305-593-0094