Provider Demographics
NPI:1790940864
Name:FAMILY MEDICAL CENTER OF HOLLYWOOD PA
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER OF HOLLYWOOD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOACHIM
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-889-0211
Mailing Address - Street 1:4050 SHERIDAN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3561
Mailing Address - Country:US
Mailing Address - Phone:954-889-0211
Mailing Address - Fax:954-889-0213
Practice Address - Street 1:4050 SHERIDAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3561
Practice Address - Country:US
Practice Address - Phone:954-889-0211
Practice Address - Fax:954-889-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty