Provider Demographics
NPI:1588832836
Name:INSTITUTE OF ADVANCE MEDICINE
Entity Type:Organization
Organization Name:INSTITUTE OF ADVANCE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANZALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-351-8889
Mailing Address - Street 1:7200 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2148
Mailing Address - Country:US
Mailing Address - Phone:954-748-4991
Mailing Address - Fax:954-748-5022
Practice Address - Street 1:7200 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2148
Practice Address - Country:US
Practice Address - Phone:954-748-4991
Practice Address - Fax:954-748-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care