Provider Demographics
NPI:1245571298
Name:CANTAVE FAMILY MEDICINE,P.A.
Entity Type:Organization
Organization Name:CANTAVE FAMILY MEDICINE,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANTAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-255-8128
Mailing Address - Street 1:8880 ROYAL PALM BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5727
Mailing Address - Country:US
Mailing Address - Phone:954-255-8128
Mailing Address - Fax:954-255-8130
Practice Address - Street 1:8880 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5727
Practice Address - Country:US
Practice Address - Phone:954-255-8128
Practice Address - Fax:954-255-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87727261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270853100Medicaid
I09781Medicare UPIN
FL43315ZMedicare PIN