Healthcare Provider Details

I. General information

NPI: 1396945481
Provider Name (Legal Business Name): GISMER MEDICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11389 W FLAGLER ST
MIAMI FL
33174-1185
US

IV. Provider business mailing address

11389 W FLAGLER ST
MIAMI FL
33174-1185
US

V. Phone/Fax

Practice location:
  • Phone: 305-480-2045
  • Fax: 305-480-2046
Mailing address:
  • Phone: 305-480-2045
  • Fax: 305-480-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0034210
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3121
License Number StateFL

VIII. Authorized Official

Name: MRS. LOURDES PEREZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-480-2045