Provider Demographics
NPI:1356664312
Name:VANGUARD MEDICAL ASSOCIATES OF SOUTH FLORIDA PA
Entity Type:Organization
Organization Name:VANGUARD MEDICAL ASSOCIATES OF SOUTH FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:G
Authorized Official - Last Name:KAPROW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-642-2280
Mailing Address - Street 1:PO BOX 292083
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33329-2083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5430 NW 33RD AVE
Practice Address - Street 2:SUITE 106 - ATTENTION DR. MARC KAPROW
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-6349
Practice Address - Country:US
Practice Address - Phone:954-642-2280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-9129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty