Basic Information
| Provider Information | |||||||||
| NPI: | 1801086335 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LANALEE ARABA SAM MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2466 E COMMERCIAL BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333084011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547764877 | ||||||||
| FaxNumber: | 9542299043 | ||||||||
| Practice Location | |||||||||
| Address1: | 2466 E COMMERCIAL BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333084011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547764877 | ||||||||
| FaxNumber: | 9542299043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2007 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | SAM | ||||||||
| AuthorizedOfficialFirstName: | LANALEE | ||||||||
| AuthorizedOfficialMiddleName: | ARABA | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9547764877 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207V00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 266303100 | 05 | FL | MEDICAID |