Healthcare Provider Details

I. General information

NPI: 1639750458
Provider Name (Legal Business Name): UNIVERSAL MEDICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NW 183RD ST STE B
MIAMI FL
33169-4250
US

IV. Provider business mailing address

700 NW 183RD ST STE B
MIAMI FL
33169-4250
US

V. Phone/Fax

Practice location:
  • Phone: 305-974-5995
  • Fax:
Mailing address:
  • Phone: 305-974-5995
  • Fax: 305-974-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIMA SAMRA
Title or Position: CLINICAL OPERATIONS COORDINATOR
Credential:
Phone: 305-974-5995