Provider Demographics
NPI:1568197994
Name:BROWARD HEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:BROWARD HEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-223-2705
Mailing Address - Street 1:7539 W OAKLAND PARK BLVD STE 41
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4909
Mailing Address - Country:US
Mailing Address - Phone:754-223-2705
Mailing Address - Fax:754-223-2836
Practice Address - Street 1:7539 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4909
Practice Address - Country:US
Practice Address - Phone:754-223-2705
Practice Address - Fax:754-223-2836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care