Provider Demographics
NPI:1083934723
Name:DOCTOR HOUSE CALLS, LLC
Entity Type:Organization
Organization Name:DOCTOR HOUSE CALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-676-7488
Mailing Address - Street 1:9858 CLINT MOORE RD
Mailing Address - Street 2:SUITE C-111-236
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1034
Mailing Address - Country:US
Mailing Address - Phone:561-676-7488
Mailing Address - Fax:561-910-4785
Practice Address - Street 1:9858 CLINT MOORE RD
Practice Address - Street 2:SUITE C-111-236
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1034
Practice Address - Country:US
Practice Address - Phone:561-676-7488
Practice Address - Fax:561-910-4785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90011208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270305000Medicaid