=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851505325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENDALL URGENT CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13550 SW 88TH ST STE 180
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-385-9919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13550 SW 88TH ST STE 180
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-385-9919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL GREGORIAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-385-9919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------