Healthcare Provider Details

I. General information

NPI: 1184860041
Provider Name (Legal Business Name): MIAMI INTERNATIONAL DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NW 170TH ST RADIOLOGY DEPARTMENT
NORTH MIAMI BEACH FL
33169-5521
US

IV. Provider business mailing address

PO BOX 530543
MIAMI SHORES FL
33153-0543
US

V. Phone/Fax

Practice location:
  • Phone: 305-654-5221
  • Fax:
Mailing address:
  • Phone: 305-654-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADAM S GROPPER
Title or Position: OWNER/SOLE SHAREHOLDER
Credential: MD
Phone: 305-654-5221