Provider Demographics
NPI:1427845411
Name:GODUR, DIMITRI ANTONIO (MS)
Entity type:Individual
Prefix:
First Name:DIMITRI
Middle Name:ANTONIO
Last Name:GODUR
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1437
Mailing Address - Country:US
Mailing Address - Phone:305-323-0893
Mailing Address - Fax:
Practice Address - Street 1:1850 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1437
Practice Address - Country:US
Practice Address - Phone:305-323-0893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program