Provider Demographics
NPI:1275201972
Name:CASA MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:CASA MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NARANBAATAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ERKHEMBAATAR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-556-8723
Mailing Address - Street 1:4601 SHERIDAN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4601 SHERIDAN ST STE 301
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3433
Practice Address - Country:US
Practice Address - Phone:786-556-8723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty