Provider Demographics
NPI:1861950149
Name:PROMED MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:PROMED MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISKHAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-428-2048
Mailing Address - Street 1:1400 NE MIAMI GARDENS DR STE 206B
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4840
Mailing Address - Country:US
Mailing Address - Phone:305-428-2048
Mailing Address - Fax:888-600-9557
Practice Address - Street 1:1400 NE MIAMI GARDENS DR STE 206B
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4840
Practice Address - Country:US
Practice Address - Phone:305-428-2048
Practice Address - Fax:888-600-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies