| |
4302 W Broward Blvd, Suite 800, Plantation, FL 33317-3780 | |
(954) 587-4300 | |
(954) 587-4018 |
Full Name | |
---|---|
Type | Facility |
Speciality | Psychiatry & Neurology - Neurology |
Location | 4302 W Broward Blvd, Plantation, Florida |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1962716506 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | CH4086 (Florida) | Secondary |
2084N0400X | Psychiatry & Neurology - Neurology | ME41982 (Florida) | Primary |
Mailing Address | Practice Location Address |
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Po Box 120068, Plantation, FL 33312-0002 Ph: (954) 587-4300 | 4302 W Broward Blvd, Suite 800, Plantation, FL 33317-3780 Ph: (954) 587-4300 |