Provider Demographics
NPI:1558900472
Name:ASSOCIATESMD MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ASSOCIATESMD MEDICAL GROUP INC
Other - Org Name:ASSOCIATESMD MEDICAL GROUP INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FELIPE
Authorized Official - Last Name:LAFRATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-434-1705
Mailing Address - Street 1:4780 SW 64TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4400
Mailing Address - Country:US
Mailing Address - Phone:954-434-1705
Mailing Address - Fax:
Practice Address - Street 1:4780 SW 64TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4400
Practice Address - Country:US
Practice Address - Phone:954-434-1705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATESMD MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty