Provider Demographics
NPI:1679702278
Name:RACHAEL GITTENS MD LLC
Entity Type:Organization
Organization Name:RACHAEL GITTENS MD LLC
Other - Org Name:OAKLAND PLAZA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GITTENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-563-8600
Mailing Address - Street 1:1100 W OAKLAND PARK BLVD
Mailing Address - Street 2:UNIT 3
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1612
Mailing Address - Country:US
Mailing Address - Phone:954-563-8600
Mailing Address - Fax:954-565-5005
Practice Address - Street 1:1100 W OAKLAND PARK BLVD
Practice Address - Street 2:UNIT 3
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-1612
Practice Address - Country:US
Practice Address - Phone:954-563-8600
Practice Address - Fax:954-565-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty