Basic Information
| Provider Information | |||||||||
| NPI: | 1073141156 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATESMD MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4780 SW 64TH AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333144400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544341705 | ||||||||
| FaxNumber: | 8006422398 | ||||||||
| Practice Location | |||||||||
| Address1: | 2004 N FLAMINGO RD | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330283500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544508500 | ||||||||
| FaxNumber: | 9544508502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2020 | ||||||||
| LastUpdateDate: | 04/01/2020 | ||||||||
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| AuthorizedOfficialLastName: | LAFRATTA | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
| AuthorizedOfficialMiddleName: | FELIPE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9544341705 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASSOCIATESMD MEDICAL GROUP INC | ||||||||
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| NPICertificationDate: | 04/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.