Provider Demographics
NPI:1639190184
Name:EAST SIDE MEDICAL CENTER OF SOUTH FLORIDA LLC
Entity Type:Organization
Organization Name:EAST SIDE MEDICAL CENTER OF SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-331-5799
Mailing Address - Street 1:100 NW 82ND AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-331-5799
Mailing Address - Fax:954-587-5018
Practice Address - Street 1:100 NW 82ND AVE STE 401
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1835
Practice Address - Country:US
Practice Address - Phone:954-331-5799
Practice Address - Fax:954-587-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID