Provider Demographics
NPI:1356454904
Name:ADULT MEDICINE OF BROWARD & PALM BEACH COUNTIES PL
Entity Type:Organization
Organization Name:ADULT MEDICINE OF BROWARD & PALM BEACH COUNTIES PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-420-0886
Mailing Address - Street 1:3467 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9473
Mailing Address - Country:US
Mailing Address - Phone:954-420-0886
Mailing Address - Fax:954-420-0964
Practice Address - Street 1:3467 W HILLSBORO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9473
Practice Address - Country:US
Practice Address - Phone:954-420-0886
Practice Address - Fax:954-420-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9220OtherPTAN