Basic Information
| Provider Information | |||||||||
| NPI: | 1265614598 | ||||||||
| 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 205 | ||||||||
| City: | LAUDERDALE LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333137260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544847030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2951 NW 49TH AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | LAUDERDALE LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333131600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544865700 | ||||||||
| FaxNumber: | 9544842574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2007 | ||||||||
| LastUpdateDate: | 11/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | ZAKEN | ||||||||
| AuthorizedOfficialFirstName: | AVA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9544847030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.