Provider Demographics
NPI:1487082079
Name:DERM BAR MD HOLDINGS LLC
Entity type:Organization
Organization Name:DERM BAR MD HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-984-0149
Mailing Address - Street 1:318 ALHAMBRA CIR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5004
Mailing Address - Country:US
Mailing Address - Phone:305-446-2121
Mailing Address - Fax:305-856-4363
Practice Address - Street 1:318 ALHAMBRA CIR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5004
Practice Address - Country:US
Practice Address - Phone:305-446-2121
Practice Address - Fax:305-856-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty