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789 S Federal Hwy Suite 106 Fort Lauderdale FL 33316-1245 | |
| (954) 689-8088 | |
| (954) 689-8147 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 789 S Federal Hwy, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Kevin Fusco (INTERIM PRESIDENT/CEO) |
| Authorized Official Contact | 9544737100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1608 Se 3rd Ave Third Floor Pbo Fort Lauderdale FL 33316-2564 Ph: (954) 847-4273 | 789 S Federal Hwy Suite 106 Fort Lauderdale FL 33316-1245 Ph: (954) 689-8088 |
| NPI Number | 1902173297 |
|---|---|
| Provider Enumeration Date | 11/30/2011 |
| Last Update Date | 01/24/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902173297 | NPI | - | NPPES |
| 253794056 | Medicaid | FL | |
| 00020 | Other | FL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208600000X | Surgery | (* (Not Available)) | Secondary |
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