Provider Demographics
NPI:1972824613
Name:GENERAL MEDICINE AND URGENT CARE CLINIC
Entity Type:Organization
Organization Name:GENERAL MEDICINE AND URGENT CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M. RAHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:FADERANI
Authorized Official - Suffix:
Authorized Official - Credentials:D,O,, MPH
Authorized Official - Phone:561-965-4300
Mailing Address - Street 1:5913 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1303
Mailing Address - Country:US
Mailing Address - Phone:561-965-4300
Mailing Address - Fax:561-965-4399
Practice Address - Street 1:5913 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1303
Practice Address - Country:US
Practice Address - Phone:561-965-4300
Practice Address - Fax:561-965-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10474261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center