Provider Demographics
NPI:1164071544
Name:DOCTORS UNITED GROUP INC
Entity Type:Organization
Organization Name:DOCTORS UNITED GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-603-8200
Mailing Address - Street 1:3215 NW 10TH TER STE 209B
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5934
Mailing Address - Country:US
Mailing Address - Phone:954-530-3586
Mailing Address - Fax:954-530-5263
Practice Address - Street 1:2150 W 76TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1882
Practice Address - Country:US
Practice Address - Phone:954-294-4493
Practice Address - Fax:954-530-5263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS UNITED GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center