Provider Demographics
NPI:1790086023
Name:INNOVATIVE CARE II, LLC
Entity Type:Organization
Organization Name:INNOVATIVE CARE II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GOKHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUVENLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-450-9595
Mailing Address - Street 1:1 SW 129TH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1717
Mailing Address - Country:US
Mailing Address - Phone:954-843-7230
Mailing Address - Fax:877-671-4101
Practice Address - Street 1:12600 PEMBROKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2544
Practice Address - Country:US
Practice Address - Phone:954-843-7230
Practice Address - Fax:877-671-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBW654ZOtherMEDICARE
FLFJ749AOtherMEDICARE PTAN