| Canyon Gate Medical Group Llc | |
|
2929 N. University Dr. Suite # 110 Coral Springs FL 33065-5081 | |
| (954) 656-8855 | |
| (954) 656-8855 |
| Full Name | Canyon Gate Medical Group Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2929 N. University Dr., Coral Springs, Florida |
| Authorized Official Name and Position | Ricki Moskow (PRESIDENT) |
| Authorized Official Contact | 9546568855 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Gate Medical Group Llc 2832 E. Lake Mead Blvd. Suite E N. Las Vegas NV 89030-6550 Ph: (702) 649-5155 | Canyon Gate Medical Group Llc 2929 N. University Dr. Suite # 110 Coral Springs FL 33065-5081 Ph: (954) 656-8855 |
| NPI Number | 1598085797 |
|---|---|
| Provider Enumeration Date | 06/10/2010 |
| Last Update Date | 06/10/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598085797 | NPI | - | NPPES |
| 1831347731 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 12804 (Nevada) | Primary |
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