Provider Demographics
NPI:1700945243
Name:DELEEUWS FAMILY CLINIC
Entity Type:Organization
Organization Name:DELEEUWS FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-920-4911
Mailing Address - Street 1:599 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4107
Mailing Address - Country:US
Mailing Address - Phone:954-920-4911
Mailing Address - Fax:954-922-9308
Practice Address - Street 1:599 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-4107
Practice Address - Country:US
Practice Address - Phone:954-920-4911
Practice Address - Fax:954-922-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty