Provider Demographics
NPI:1912202797
Name:VANGUARD MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:VANGUARD MEDICAL GROUP LLC
Other - Org Name:BROWARD PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACCC,FACP,FSCAI
Authorized Official - Phone:954-436-6660
Mailing Address - Street 1:1330 RIVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2961
Mailing Address - Country:US
Mailing Address - Phone:954-321-9826
Mailing Address - Fax:954-321-9660
Practice Address - Street 1:1330 RIVERLAND RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2961
Practice Address - Country:US
Practice Address - Phone:954-321-9826
Practice Address - Fax:954-321-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty