Provider Demographics
NPI:1801412408
Name:LAUREL MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:LAUREL MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:UCHOA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-378-3386
Mailing Address - Street 1:5911 NE 14TH LN
Mailing Address - Street 2:104
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:786-378-3386
Mailing Address - Fax:954-206-5595
Practice Address - Street 1:5911 NE 14TH LN
Practice Address - Street 2:104
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:786-378-3386
Practice Address - Fax:954-206-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty