MEDICARE: UNILAB OF DADE 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	291U00000X	Clinical Medical Laboratory	10D0284855	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10D0284855	OTHER	FL	CLIA #

General Provider Information

NPI Number	:	1922007947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNILAB OF DADE INC

Provider Business Mailing Address
First Line	:	2145 DAVIE BLVD
Second Line	:	#106
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-3161
Country	:	US
Telephone Number	:	954-792-7422
Fax Number	:	954-797-9494

Provider Business Practice Location Address
First Line	:	2145 DAVIE BLVD
Second Line	:	#106
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-3161
Country	:	US
Telephone Number	:	954-792-7422
Fax Number	:	954-797-9494

Authorized Official
Title or Position	:	V.P
Name	:	MR. JULIO E CORTES JR.
Credential	:	BS
Telephone Number	:	954-792-7422

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/20/2010

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Directions to “UNILAB OF DADE INC ” Practice Location

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