Basic Information
Provider Information | |||||||||
NPI: | 1053416339 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FLORIDA INSTITUTE OF HEALTH LTD LLLP | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4850 W OAKLAND PARK BLVD | ||||||||
Address2: | SUITE 205 | ||||||||
City: | LAUDERDALE LAKES | ||||||||
State: | FL | ||||||||
PostalCode: | 333137260 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9544847030 | ||||||||
FaxNumber: | 9544841280 | ||||||||
Practice Location | |||||||||
Address1: | 7351 W OAKLAND PARK BLVD | ||||||||
Address2: | SUITE 104 | ||||||||
City: | TAMARAC | ||||||||
State: | FL | ||||||||
PostalCode: | 333197107 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9547415800 | ||||||||
FaxNumber: | 9547417828 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/13/2006 | ||||||||
LastUpdateDate: | 10/24/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ZAKEN | ||||||||
AuthorizedOfficialFirstName: | AVA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
AuthorizedOfficialTelephone: | 9544847030 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.