Healthcare Provider Details

I. General information

NPI: 1760052849
Provider Name (Legal Business Name): DADE INTERNAL MEDICINE AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 10/08/2022
Certification Date: 10/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NE 123RD ST STE 417
NORTH MIAMI FL
33181-2885
US

IV. Provider business mailing address

811 NE 122ND ST
NORTH MIAMI FL
33161-5725
US

V. Phone/Fax

Practice location:
  • Phone: 786-534-4907
  • Fax: 980-495-8939
Mailing address:
  • Phone: 305-962-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS A PEREZ
Title or Position: SOLE PROPRIETOR
Credential: DO
Phone: 305-962-2811