Healthcare Provider Details

I. General information

NPI: 1831436310
Provider Name (Legal Business Name): SOUTHEAST URGENT CARE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 IVES DAIRY RD 115
MIAMI FL
33179-2537
US

IV. Provider business mailing address

1021 IVES DAIRY RD 115
MIAMI FL
33179-2537
US

V. Phone/Fax

Practice location:
  • Phone: 786-440-5130
  • Fax: 786-440-5219
Mailing address:
  • Phone: 786-440-5130
  • Fax: 786-440-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH 9049
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH 4902
License Number StateFL

VIII. Authorized Official

Name: DR. HENRI DOUZE
Title or Position: OWNER
Credential: D.C.
Phone: 786-440-5130