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Organization

DOC ROAD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JONATHAN GRUNER (OWNER)
(954) 231-5148
Entity
Organization

Contact information

Practice address
48 NW 25TH ST STE 102, MIAMI, FL 33127-4442
(954) 231-5148
Mailing address
3711 PINE TREE DR, MIAMI BEACH, FL 33140-3935
(954) 231-5148

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary

Other

Enumeration date
05/06/2022
Last updated
05/30/2024
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