Provider Demographics
NPI:1073629168
Name:FLORIDA INSTITUTE OF HEALTH, LTD UCP
Entity Type:Organization
Organization Name:FLORIDA INSTITUTE OF HEALTH, LTD UCP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-484-7030
Mailing Address - Street 1:4850 WEST OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313
Mailing Address - Country:US
Mailing Address - Phone:954-484-7030
Mailing Address - Fax:954-484-1280
Practice Address - Street 1:4850 WEST OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 145
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:954-739-0978
Practice Address - Fax:954-739-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL395230Medicare ID - Type Unspecified