Healthcare Provider Details

I. General information

NPI: 1285748285
Provider Name (Legal Business Name): SOUTH DADE PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date: 04/26/2023
Reactivation Date: 05/10/2023

III. Provider practice location address

1000 NW 57TH CT STE 400
MIAMI FL
33126-3292
US

IV. Provider business mailing address

1000 NW 57TH CT STE 400
MIAMI FL
33126-3292
US

V. Phone/Fax

Practice location:
  • Phone: 786-239-5791
  • Fax:
Mailing address:
  • Phone: 786-239-5791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK L MULLINIX
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: AUTHORIZED OFFICIAL
Phone: 786-758-3135