Organization
PERSONALIZED MEDICINE INSTITUTE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAXIMO JOSE FERNANDEZ MD (CEO)
(954) 552-7209
Entity
Organization
Contact information
Practice address
4765 SW 148TH AVE STE 404, DAVIE, FL 33330-2128
(203) 300-0147
(954) 634-4293
Mailing address
4765 VOLUNTEER RD STE 404, DAVIE, FL 33330-2128
(954) 374-7545
(954) 374-7543
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME107216
INTERNAL MEDICINE
FL
Enumeration date
11/06/2018
Last updated
09/15/2025
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