Provider Demographics
NPI:1730443268
Name:SUMMIT CLINICAL DIAGNOSTIC GROUP LLC
Entity type:Organization
Organization Name:SUMMIT CLINICAL DIAGNOSTIC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOAO
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-274-4501
Mailing Address - Street 1:11140 NORTH KENDALL DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176
Mailing Address - Country:US
Mailing Address - Phone:305-546-3637
Mailing Address - Fax:305-274-4549
Practice Address - Street 1:11140 N. KENDALL DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-546-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X
FL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service