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General NPI Number Information
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NPI Number | 1114769767
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Entity Type | Organization
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Legal Business Name | LUMINARY DERMATOLOGY OF MIAMI, LLC
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Dates
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Enumeration Date | 06/12/2024
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 8740 N KENDALL DR STE 101
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City | MIAMI
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State | FL
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Zip | 33176-2209
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Country | US
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Telephone | 305-661-8978
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Fax | 941-296-8501
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Provider Business Mailing Address
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Address Line | 4411 BEE RIDGE RD # 309
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City | SARASOTA
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State | FL
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Zip | 34233-2514
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Country | US
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Telephone | 941-926-6553
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Fax | 941-296-8501
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Authorized Official
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Title or Position | CEO
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Name | JESSICA PHILLIPS
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Credential |
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Telephone | 941-926-6553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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