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General NPI Number Information
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NPI Number | 1265946511
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Entity Type | Organization
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Legal Business Name | OBGYN OF MIRAMAR, P.A.
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Dates
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Enumeration Date | 11/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 601 N FLAMINGO RD STE 305
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1010
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Country | US
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Telephone | 866-236-2906
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Fax |
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Provider Business Mailing Address
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Address Line | 3541 SW 142ND AVE
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City | MIRAMAR
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State | FL
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Zip | 33027-4705
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Country | US
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Telephone | 239-738-1455
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Fax |
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Authorized Official
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Title or Position | OB/GYN
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Name | DR. DIMITRI P LOPEZ LINNIKOV
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Credential | MD
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Telephone | 239-738-1455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME115729
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License Number State | FL
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