Provider Demographics
NPI:1306117320
Name:MIAMI SHORES HOLISTIC HEALTH, INC.
Entity type:Organization
Organization Name:MIAMI SHORES HOLISTIC HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-999-5527
Mailing Address - Street 1:9999 NE 2ND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2346
Mailing Address - Country:US
Mailing Address - Phone:305-999-5527
Mailing Address - Fax:
Practice Address - Street 1:9999 NE 2ND AVE STE 300
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2346
Practice Address - Country:US
Practice Address - Phone:305-999-5527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2999261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center