Provider Demographics
NPI:1255766218
Name:MEDICAL CARE GROUP LLC
Entity type:Organization
Organization Name:MEDICAL CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-444-7887
Mailing Address - Street 1:4431 SW 64TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3458
Mailing Address - Country:US
Mailing Address - Phone:786-444-7887
Mailing Address - Fax:
Practice Address - Street 1:4431 SW 64TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3458
Practice Address - Country:US
Practice Address - Phone:786-444-7887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty