Provider Demographics
NPI:1508202003
Name:441 WALK IN CLINIC LLC
Entity Type:Organization
Organization Name:441 WALK IN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAREL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:786-282-7099
Mailing Address - Street 1:PO BOX 693332
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33269-0332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3908 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6162
Practice Address - Country:US
Practice Address - Phone:786-282-7099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-12
Last Update Date:2013-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center