Healthcare Provider Details

I. General information

NPI: 1003431131
Provider Name (Legal Business Name): INNOVATIVE DURABLE MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16400 NE 19TH AVE
NORTH MIAMI BEACH FL
33162-4115
US

IV. Provider business mailing address

16400 NE 19TH AVE
NORTH MIAMI BEACH FL
33162-4115
US

V. Phone/Fax

Practice location:
  • Phone: 305-864-1373
  • Fax: 305-868-3124
Mailing address:
  • Phone: 305-864-1373
  • Fax: 305-868-3124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DMITRY SANDLER
Title or Position: OWNER
Credential: DPM
Phone: 305-864-1373