Provider Demographics
NPI:1518855931
Name:FAMILY MEDICAL GROUP DORAL LLC
Entity type:Organization
Organization Name:FAMILY MEDICAL GROUP DORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-504-6044
Mailing Address - Street 1:12391 SW 130TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6208
Mailing Address - Country:US
Mailing Address - Phone:305-504-6044
Mailing Address - Fax:
Practice Address - Street 1:3470 NW 82ND AVE STE 110
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1026
Practice Address - Country:US
Practice Address - Phone:305-504-6044
Practice Address - Fax:305-707-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care