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General NPI Number Information
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NPI Number | 1720063092
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Entity Type | Organization
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Legal Business Name | METRO DADE FIRE FIGHTERS WELLNESS CENTER
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8000 NW 21ST ST SUITE 200
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City | DORAL
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State | FL
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Zip | 33122-1620
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Country | US
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Telephone | 305-477-2329
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Fax | 305-477-3039
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Provider Business Mailing Address
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Address Line | 8000 NW 21ST ST SUITE 200
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City | DORAL
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State | FL
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Zip | 33122-1620
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Country | US
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Telephone | 305-477-2329
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Fax | 305-477-3039
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MICHELE AMY GRUNDSTEIN
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Credential | M.D.
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Telephone | 305-477-2329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME74252
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License Number State | FL
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