Provider Demographics
NPI:1255573879
Name:LAUDERDALE HEALTH AND WELLNESS INC.
Entity type:Organization
Organization Name:LAUDERDALE HEALTH AND WELLNESS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:THACKREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-688-4072
Mailing Address - Street 1:6400 N ANDREWS AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2114
Mailing Address - Country:US
Mailing Address - Phone:954-688-4072
Mailing Address - Fax:954-653-7209
Practice Address - Street 1:6400 N ANDREWS AVE
Practice Address - Street 2:STE 120
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2114
Practice Address - Country:US
Practice Address - Phone:954-688-4072
Practice Address - Fax:954-653-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME932872083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty