| Personalized Medicine Institute, Llc. | |
|
4765 Sw 148th Ave Ste 404 Davie FL 33330-2128 | |
| (203) 300-0147 | |
| (954) 634-4293 |
| Full Name | Personalized Medicine Institute, Llc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4765 Sw 148th Ave Ste 404, Davie, Florida |
| Authorized Official Name and Position | Ivel Cristina De Freitas (OWNER) |
| Authorized Official Contact | 2033000147 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Personalized Medicine Institute, Llc. 6030 Reese Rd Apt 404 Davie FL 33314-1243 Ph: (203) 300-0147 | Personalized Medicine Institute, Llc. 4765 Sw 148th Ave Ste 404 Davie FL 33330-2128 Ph: (203) 300-0147 |
| NPI Number | 1376011551 |
|---|---|
| Provider Enumeration Date | 11/06/2018 |
| Last Update Date | 03/28/2020 |
| Medicare PECOS PAC ID | 9436487725 |
|---|---|
| Medicare Enrollment ID | O20190823003167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376011551 | NPI | - | NPPES |
| ME107216 | Other | FL | INTERNAL MEDICINE |
| Provider Name | Maximo J Fernandez |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1215119185 PECOS PAC ID: 0345413126 Enrollment ID: I20111024000709 |
| Provider Name | Ivel Christina De Freitas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457543746 PECOS PAC ID: 2769549997 Enrollment ID: I20120118000228 |
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