MEDICARE: SOUTH MIAMI 3 DIMENSIONAL INSTITUTE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1649341439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MIAMI 3 DIMENSIONAL INSTITUTE INC

Provider Business Mailing Address
First Line	:	6201 SW 70TH ST STE 103
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-4718
Country	:	US
Telephone Number	:	305-828-1070
Fax Number	:	305-828-8208

Provider Business Practice Location Address
First Line	:	6201 SW 70TH ST STE 103
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-4718
Country	:	US
Telephone Number	:	305-828-1070
Fax Number	:	305-828-8208

Authorized Official
Title or Position	:	PD
Name	:	DEBORAH PINERO
Credential	:
Telephone Number	:	305-828-1070

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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