| West Broward Internal Medicine Pllc | |
|
6451 W Commercial Blvd Tamarac FL 33319-2110 | |
| (954) 720-1414 | |
| (954) 720-4727 |
| Full Name | West Broward Internal Medicine Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6451 W Commercial Blvd, Tamarac, Florida |
| Authorized Official Name and Position | Shahrad Mabourakh (PHYSICIAN) |
| Authorized Official Contact | 9547201414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Broward Internal Medicine Pllc 6451 W Commercial Blvd Tamarac FL 33319-2110 Ph: (954) 720-1414 | West Broward Internal Medicine Pllc 6451 W Commercial Blvd Tamarac FL 33319-2110 Ph: (954) 720-1414 |
| NPI Number | 1871765727 |
|---|---|
| Provider Enumeration Date | 04/01/2008 |
| Last Update Date | 11/27/2023 |
| Medicare PECOS PAC ID | 1951470970 |
|---|---|
| Medicare Enrollment ID | O20080516000500 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871765727 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME67283 (Florida) | Primary |
| Provider Name | Shahrad Mabourakh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053388090 PECOS PAC ID: 2365511375 Enrollment ID: I20080516000439 |
| Provider Name | Patricia C Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033185616 PECOS PAC ID: 7911076856 Enrollment ID: I20080519000764 |
| Provider Name | Matthew Jay Wolland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699177717 PECOS PAC ID: 2860756525 Enrollment ID: I20180503002249 |
| Provider Name | Davita M Mabourakh |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1639675937 PECOS PAC ID: 9931582632 Enrollment ID: I20230705003210 |
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