Provider Demographics
NPI:1063671246
Name:EMAD EKLADIOS M D P A
Entity Type:Organization
Organization Name:EMAD EKLADIOS M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:EZRA
Authorized Official - Last Name:EKLADIOS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:954-963-2555
Mailing Address - Street 1:PO BOX 848488
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33084-0488
Mailing Address - Country:US
Mailing Address - Phone:954-963-2555
Mailing Address - Fax:954-963-2288
Practice Address - Street 1:2231 N UNIVERSITY DR
Practice Address - Street 2:SUITE C
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3611
Practice Address - Country:US
Practice Address - Phone:954-963-2555
Practice Address - Fax:954-963-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064340261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375033700Medicaid
FL375033700Medicaid