Provider Demographics
NPI:1972849263
Name:G H WAKED MD INC
Entity Type:Organization
Organization Name:G H WAKED MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-721-0700
Mailing Address - Street 1:7421 N UNIVERSITY DR STE 214
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6102
Mailing Address - Country:US
Mailing Address - Phone:954-721-0700
Mailing Address - Fax:954-722-5857
Practice Address - Street 1:7421 N UNIVERSITY DR STE 214
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6102
Practice Address - Country:US
Practice Address - Phone:954-721-0700
Practice Address - Fax:954-722-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTANOther93715
FLD60560Medicare UPIN