Provider Demographics
NPI:1962507244
Name:FLORIDA INSTITUTE OF HEALTH LTD LLLP
Entity Type:Organization
Organization Name:FLORIDA INSTITUTE OF HEALTH LTD LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-484-7030
Mailing Address - Street 1:4850 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7260
Mailing Address - Country:US
Mailing Address - Phone:954-484-7030
Mailing Address - Fax:954-484-1280
Practice Address - Street 1:4850 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7260
Practice Address - Country:US
Practice Address - Phone:954-484-4440
Practice Address - Fax:954-484-9250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39523EMedicare ID - Type Unspecified