Provider Demographics
NPI:1558463810
Name:INTERNAL MEDICINE ASSOCIATES OF FL
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-336-9615
Mailing Address - Street 1:1720 VICTORIA POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1306
Mailing Address - Country:US
Mailing Address - Phone:954-336-9615
Mailing Address - Fax:954-450-2504
Practice Address - Street 1:601 N FLAMINGO ROAD
Practice Address - Street 2:SUITE#206A
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028
Practice Address - Country:US
Practice Address - Phone:954-336-9615
Practice Address - Fax:954-450-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271335700Medicaid
FLK6873Medicare PIN