Healthcare Provider Details

I. General information

NPI: 1932423449
Provider Name (Legal Business Name): DIGESTIVE MEDICINE HISTOLOGY LAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W 68TH ST SUITE 103
HIALEAH FL
33016-1815
US

IV. Provider business mailing address

2140 W 68TH ST SUITE 305
HIALEAH FL
33016-1815
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-4107
  • Fax: 305-822-5086
Mailing address:
  • Phone: 305-822-4107
  • Fax: 305-822-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCISCO R MADERAL
Title or Position: PHYSICIAN
Credential: MD
Phone: 305-822-4107