Provider Demographics
NPI:1942572805
Name:INSTITUTO MEDICO DEL DOLOR LLC
Entity type:Organization
Organization Name:INSTITUTO MEDICO DEL DOLOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D
Authorized Official - Prefix:
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KARANDISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-536-9656
Mailing Address - Street 1:717 PONCE DE LEON BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2048
Mailing Address - Country:US
Mailing Address - Phone:786-536-9656
Mailing Address - Fax:786-536-9653
Practice Address - Street 1:717 PONCE DE LEON BLVD STE 218
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2048
Practice Address - Country:US
Practice Address - Phone:786-536-9656
Practice Address - Fax:786-536-9653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103915261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)