Unknown Individual – Specialist, NPI 1104924919
Specialist
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
State Road 7, Lauderdale Lakes, Broward County, Florida, 33319-5617, United States
SUITE 201
LAUDERDALE LAKES, FL 333195839
Phone: (954) 486-4005
Fax: (954) 497-3857
Type: Mailing
1957, Jackson Street, Hollywood, Broward County, Florida, 33020, United States
HOLLYWOOD, FL 330205021
Phone: (954) 921-2600
Fax: (954) 497-3857
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33319)
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