=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205208139
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INNOVATIVE MEDICAL RESEARCH OF SOUTH FLORIDA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2015
-----------------------------------------------------
Last Update Date | 10/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20880 WEST DIXIE HIGHWAY SUITE 103
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-757-2226
-----------------------------------------------------
Fax | 305-405-0535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20880 WEST DIXIE HIGHWAY SUITE 103
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-757-2226
-----------------------------------------------------
Fax | 305-405-0535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARC A SALTZMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-759-1881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1744R1102X
-----------------------------------------------------
Taxonomy Name | Research Study Specialist
-----------------------------------------------------
License Number | ME20954
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------