| Dedicated Indiana Holding Llc | |
|
1395 Nw 167th St Miami Gardens FL 33169-5710 | |
| (305) 628-6117 | |
| Not Available |
| Full Name | Dedicated Indiana Holding Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1395 Nw 167th St, Miami Gardens, Florida |
| Authorized Official Name and Position | Mary Chen (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3056286117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dedicated Indiana Holding Llc 1395 Nw 167th St Miami Gardens FL 33169-5710 Ph: (305) 628-6117 | Dedicated Indiana Holding Llc 1395 Nw 167th St Miami Gardens FL 33169-5710 Ph: (305) 628-6117 |
| NPI Number | 1831977479 |
|---|---|
| Provider Enumeration Date | 09/15/2023 |
| Last Update Date | 09/15/2023 |
| Medicare PECOS PAC ID | 7214382290 |
|---|---|
| Medicare Enrollment ID | O20231011001508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831977479 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Gordon L Chen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912108317 PECOS PAC ID: 1456535665 Enrollment ID: I20231011001621 |
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