Provider Demographics
NPI:1700195930
Name:BROWARD MEDICAL SPECIALIST INC
Entity Type:Organization
Organization Name:BROWARD MEDICAL SPECIALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIPRIANOS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ARMENAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-888-5656
Mailing Address - Street 1:2205 BAY DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-2912
Mailing Address - Country:US
Mailing Address - Phone:754-888-5656
Mailing Address - Fax:954-785-8333
Practice Address - Street 1:2205 BAY DR
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-2912
Practice Address - Country:US
Practice Address - Phone:754-888-5656
Practice Address - Fax:954-785-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 107125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty