Provider Demographics
NPI:1770373581
Name:ASSOCIATESMD MEDICAL GROUP INC
Entity type:Organization
Organization Name:ASSOCIATESMD MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FELIPE
Authorized Official - Last Name:LAFRATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-434-1705
Mailing Address - Street 1:4780 SW 64TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4400
Mailing Address - Country:US
Mailing Address - Phone:954-434-1705
Mailing Address - Fax:
Practice Address - Street 1:600 S PINE ISLAND RD STE 104
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3178
Practice Address - Country:US
Practice Address - Phone:954-474-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATESMD MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care