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General NPI Number Information
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NPI Number | 1003008129
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Entity Type | Organization
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Legal Business Name | MEDSERVE OF DADE COUNTY
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 15328 NW 7TH AVE
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City | MIAMI
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State | FL
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Zip | 33169
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Country | US
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Telephone | 786-235-0103
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Fax | 305-681-5620
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Provider Business Mailing Address
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Address Line | 15328 NW 7TH AVE
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City | MIAMI
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State | FL
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Zip | 33169
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Country | US
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Telephone | 786-235-0103
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Fax | 305-681-5620
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Authorized Official
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Title or Position | OWNER
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Name | MR. JACOB VAKS
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Credential |
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Telephone | 305-610-3450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME 77467
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT15239
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License Number State | FL
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