Basic Information
| Provider Information | |||||||||
| NPI: | 1184730202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA INSTITUTE OF HEALTH, LTD LLLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4850 W OAKLAND PARK BLVD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | LAUDERDALE LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333137260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544847030 | ||||||||
| FaxNumber: | 9544841280 | ||||||||
| Practice Location | |||||||||
| Address1: | 7646 NOB HILL RD | ||||||||
| Address2: | |||||||||
| City: | TAMARAC | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544840800 | ||||||||
| FaxNumber: | 9547216370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 04/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRANTLEY | ||||||||
| AuthorizedOfficialFirstName: | RAWNDRIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9544847030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 04/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.