Provider Demographics
NPI:1144408642
Name:SOUTH FLORIDA MEDICAL ASSOC PA
Entity Type:Organization
Organization Name:SOUTH FLORIDA MEDICAL ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NACCARATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-937-2229
Mailing Address - Street 1:3800 S OCEAN DR
Mailing Address - Street 2:230
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2927
Mailing Address - Country:US
Mailing Address - Phone:954-455-9700
Mailing Address - Fax:305-455-9766
Practice Address - Street 1:3800 S OCEAN DR
Practice Address - Street 2:230
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-2927
Practice Address - Country:US
Practice Address - Phone:954-455-9700
Practice Address - Fax:305-455-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53968207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE31275Medicare UPIN
FL21227BMedicare PIN