Healthcare Provider Details

I. General information

NPI: 1518929603
Provider Name (Legal Business Name): OMI CT OF MIAMI LAKES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15410 NW 77 COURT SUITE 250
MIAMI LAKES FL
33016
US

IV. Provider business mailing address

2200 N COMMERCE PARKWAY SUITE 100
WESTON FL
33326
US

V. Phone/Fax

Practice location:
  • Phone: 305-828-7211
  • Fax: 305-828-7270
Mailing address:
  • Phone: 954-888-6411
  • Fax: 954-888-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALAN BABITZ
Title or Position: CFO
Credential:
Phone: 954-888-6411