Provider Demographics
NPI:1548270101
Name:DESIGN NEUROSCIENCE CENTER PL
Entity type:Organization
Organization Name:DESIGN NEUROSCIENCE CENTER PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KESTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEDD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-653-5155
Mailing Address - Street 1:14400 NW 77TH CT STE 306
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1592
Mailing Address - Country:US
Mailing Address - Phone:305-653-5155
Mailing Address - Fax:305-653-5513
Practice Address - Street 1:14400 NW 77TH CT STE 306
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1592
Practice Address - Country:US
Practice Address - Phone:305-653-5155
Practice Address - Fax:305-653-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4730207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG090Medicare PIN