Basic Information
| Provider Information | |||||||||
| NPI: | 1881799625 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA INSTITUTE OF HEALTH LTD LLLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4850 WEST OAKLAND PARK BLVD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LAUDERDALE LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544847030 | ||||||||
| FaxNumber: | 9544841280 | ||||||||
| Practice Location | |||||||||
| Address1: | 7050 NW 4TH ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333172247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545874112 | ||||||||
| FaxNumber: | 9545872401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 02/29/2008 | ||||||||
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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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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.