Provider Demographics
NPI:1386820942
Name:GLADES PRIMARY CARE LLC
Entity Type:Organization
Organization Name:GLADES PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHEKHAR
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-795-9087
Mailing Address - Street 1:3347 STATE ROAD 7
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8095
Mailing Address - Country:US
Mailing Address - Phone:561-996-7742
Mailing Address - Fax:561-798-4779
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-7808
Practice Address - Country:US
Practice Address - Phone:561-996-7742
Practice Address - Fax:561-798-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI894AMedicare PIN