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General NPI Number Information
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NPI Number | 1245039296
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Entity Type | Organization
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Legal Business Name | MD INDIVIDUAL SERVICES INC
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 12855 SW 136TH AVE STE 211
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City | MIAMI
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State | FL
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Zip | 33186-5828
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Country | US
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Telephone | 305-979-6178
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Fax | 305-979-6178
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Provider Business Mailing Address
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Address Line | 12855 SW 136TH AVE STE 211
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City | MIAMI
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State | FL
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Zip | 33186-5828
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Country | US
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Telephone | 305-979-6178
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Fax | 305-979-6178
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOEL A QUINTANA
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Credential |
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Telephone | 305-979-6178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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