Healthcare Provider Details

I. General information

NPI: 1508995747
Provider Name (Legal Business Name): SOUTHDADE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9765 SW 184TH ST
MIAMI FL
33157-6932
US

IV. Provider business mailing address

9765 SW 184TH ST
MIAMI FL
33157-6932
US

V. Phone/Fax

Practice location:
  • Phone: 305-255-3950
  • Fax:
Mailing address:
  • Phone: 305-255-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberOS1516
License Number StateFL

VIII. Authorized Official

Name: DR. JULES GARY MINKES
Title or Position: OWENR
Credential: M.D.
Phone: 305-255-3950