| Proactive Medical Group Llc | |
|
5353 N Federal Hwy Ste 400 Fort Lauderdale FL 33308-3244 | |
| (954) 938-2843 | |
| (954) 200-6689 |
| Full Name | Proactive Medical Group Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5353 N Federal Hwy Ste 400, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Ricardo Alexander Zambrano (OWNER) |
| Authorized Official Contact | 9549382843 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Medical Group Llc 5353 N Federal Hwy Ste 400 Fort Lauderdale FL 33308-3244 Ph: (954) 938-2843 | Proactive Medical Group Llc 5353 N Federal Hwy Ste 400 Fort Lauderdale FL 33308-3244 Ph: (954) 938-2843 |
| NPI Number | 1225765241 |
|---|---|
| Provider Enumeration Date | 08/02/2022 |
| Last Update Date | 01/01/2024 |
| Medicare PECOS PAC ID | 5597138123 |
|---|---|
| Medicare Enrollment ID | O20230302000692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225765241 | NPI | - | NPPES |
| U5083 | Other | TX | TEXAS MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jose G Cevallos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922236736 PECOS PAC ID: 7719112382 Enrollment ID: I20131107000497 |
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