Healthcare Provider Details

I. General information

NPI: 1992883383
Provider Name (Legal Business Name): PULMONARY PROVIDERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21408 W DIXIE HWY
MIAMI FL
33180-1144
US

IV. Provider business mailing address

21408 W DIXIE HWY
MIAMI FL
33180-1144
US

V. Phone/Fax

Practice location:
  • Phone: 305-830-0202
  • Fax: 305-830-0204
Mailing address:
  • Phone: 305-830-0202
  • Fax: 305-830-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number051640
License Number StateFL

VIII. Authorized Official

Name: MR. DANIEL LIVSHIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 305-302-2900