Provider Demographics
NPI:1609683010
Name:OTANTIK MEDICAL CENTER
Entity type:Organization
Organization Name:OTANTIK MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:JEAN FRANCOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-882-0164
Mailing Address - Street 1:18921 NW 2ND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18921 NW 2ND AVE STE C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4004
Practice Address - Country:US
Practice Address - Phone:954-882-0164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care