Provider Demographics
NPI:1316412836
Name:OSTEOPATHIC MEDICAL ARTS CENTER OF SOUTH FLORIDA LLC
Entity Type:Organization
Organization Name:OSTEOPATHIC MEDICAL ARTS CENTER OF SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDERE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-381-7334
Mailing Address - Street 1:1201 NE 26TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1206
Mailing Address - Country:US
Mailing Address - Phone:954-838-1173
Mailing Address - Fax:888-809-1631
Practice Address - Street 1:3700 WASHINGTON ST STE 401
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8249
Practice Address - Country:US
Practice Address - Phone:954-955-6622
Practice Address - Fax:888-809-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty