Provider Demographics
NPI:1194474304
Name:VIVAMAS MEDICAL CENTER - KENDALL, LLC
Entity type:Organization
Organization Name:VIVAMAS MEDICAL CENTER - KENDALL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-584-4600
Mailing Address - Street 1:5775 BLUE LAGOON DR STE 450
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2591
Mailing Address - Country:US
Mailing Address - Phone:786-584-4600
Mailing Address - Fax:833-778-7787
Practice Address - Street 1:8601 SW 124TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4601
Practice Address - Country:US
Practice Address - Phone:305-972-4382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty