Provider Demographics
NPI:1881976819
Name:BODYCARE LIPOSCULTURE AND ANTI-AGING CLINIC
Entity type:Organization
Organization Name:BODYCARE LIPOSCULTURE AND ANTI-AGING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:G
Authorized Official - Last Name:STRATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-765-1316
Mailing Address - Street 1:100 N FEDERAL HWY
Mailing Address - Street 2:THE WAVERLY AT LAS OLAS
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1129
Mailing Address - Country:US
Mailing Address - Phone:954-765-1316
Mailing Address - Fax:954-765-1461
Practice Address - Street 1:100 N FEDERAL HWY
Practice Address - Street 2:THE WAVERLY AT LAS OLAS
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1129
Practice Address - Country:US
Practice Address - Phone:954-765-1316
Practice Address - Fax:954-765-1461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODYCARE LIPOSCULTURE AND ANTI-AGING CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG31763Medicare UPIN
FLU2962XMedicare UPIN