Provider Demographics
NPI:1013585868
Name:FLORIDA CONCIERGE MEDICINE & WELLNESS LLC
Entity Type:Organization
Organization Name:FLORIDA CONCIERGE MEDICINE & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:FRANTZ
Authorized Official - Last Name:ACLOQUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:954-932-3269
Mailing Address - Street 1:5555 HOLLYWOOD BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6420
Mailing Address - Country:US
Mailing Address - Phone:954-932-3269
Mailing Address - Fax:
Practice Address - Street 1:5555 HOLLYWOOD BLVD STE 201
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6420
Practice Address - Country:US
Practice Address - Phone:954-932-3269
Practice Address - Fax:954-361-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty