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General NPI Number Information
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NPI Number | 1902771546
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Entity Type | Organization
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Legal Business Name | MIAMI DERMATOLOGY AND SURGERY, LLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 3659 S MIAMI AVE STE 4002
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City | MIAMI
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State | FL
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Zip | 33133-4231
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Country | US
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Telephone | 305-456-1425
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Fax | 305-530-8968
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Provider Business Mailing Address
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Address Line | 3659 S MIAMI AVE STE 4002
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City | MIAMI
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State | FL
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Zip | 33133-4231
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Country | US
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Telephone | 305-456-1425
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Fax | 305-530-8968
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Authorized Official
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Title or Position | MANAGER/CO-FOUNDER
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Name | PETER BITTAR
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Credential | MD
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Telephone | 812-239-9233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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