| Broward Health Medical Group | |
|
7539 W Oakland Park Blvd Tamarac FL 33319-4909 | |
| (754) 223-2705 | |
| (754) 223-2836 |
| Full Name | Broward Health Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 7539 W Oakland Park Blvd, Tamarac, Florida |
| Authorized Official Name and Position | Shanna Stephen (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7542232705 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broward Health Medical Group 7539 W Oakland Park Blvd Ste 41 Tamarac FL 33319-4909 Ph: (754) 223-2705 | Broward Health Medical Group 7539 W Oakland Park Blvd Tamarac FL 33319-4909 Ph: (754) 223-2705 |
| NPI Number | 1568197994 |
|---|---|
| Provider Enumeration Date | 07/20/2022 |
| Last Update Date | 01/17/2023 |
| Medicare PECOS PAC ID | 4880070507 |
|---|---|
| Medicare Enrollment ID | O20221004002286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568197994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jean Michel Amisial |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255612065 PECOS PAC ID: 0648430678 Enrollment ID: I20120328000494 |
| Provider Name | Raymonde Vernet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619526167 PECOS PAC ID: 1153740881 Enrollment ID: I20200930001211 |
| Provider Name | Shanna Stephen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1003236175 PECOS PAC ID: 7719289909 Enrollment ID: I20221004002997 |
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